Integrative Women's Health

Reality Sandwich

2009-01-26T17:26:00.001-07:00

Daniel Pinchbeck, author of "2012: The Return of Queztlcoatl" has a consciousness website called Reality Sandwich and I have an article posted there on Medical Materialism. Check it out and leave a comment

http://www.realitysandwich.com/medical_materialism_exploring_allopathic_paradigm_through_shamanistic_practices

Article on Reality Sandwich

2009-01-26T08:26:00.002-07:00

Daniel Pinchbeck's consciousness website Reality Sandwich has published one of my articles.

Check it out and make a comment

http://www.realitysandwich.com/medical_materialism_exploring_allopathic_paradigm_through_shamanistic_practices

Article on Reality Sandwich

2009-01-26T08:26:00.000-07:00

Daniel Pinchbeck - author of Breaking Open the Head and 2012: The Return of Queztlcoatl has a consciousness studies website called Reality Sandwich and he was kind enough to publish one of my article on his website.

Check it out and make a comment.

http://www.realitysandwich.com/medical_materialism_exploring_allopathic_paradigm_through_shamanistic_practices

Biofeedback

2009-01-20T12:44:00.003-07:00

I am sitting here in San Francisco learning about Biofeedback and its role in healthcare. Part of this training is a continuation of my PhD training in Mind-Body Medicine at Saybrook Grduate and Research Center.

Biofeedback is a relatively new modality with regards to other medical treatments and it is a truly exciting field. Biofeedback is a form of monitoring the energy of the skin with both galvanic skin reception and EMG combined with control of temperature of the body. The thought is that as you have increased stress levels, the small capillaries and arterioles in your fingers constrict and become cold. When the arterioles are relaxed and dilated then there is increase sweat from the small glands on the skin and skin temperature and sweating are also decreased. Over time this type of controlled medicine or medical practice is easy to do, but requires work from the patient when they go home.

The BCIA or Biofeedback Institute of America is the legal body that credentials individuals to perform biofeedback. As a physician in gynecologic practice, bringing in biofeedback as an adjunct to the care of our patients seems like an easy decision. Patients with pelvic floor prolapse or urinary incontinence could benefit from this type of a program by giving them increased control of musculature prior and after surgical intervention. If a woman is to have a mesh of the vagina for prolapse it makes sense for them to maximize their results or stay out of the operating room in the first place.

BCIA has a specific credentialing process for pelvic floor and I will be pursuing this to aid in my knowledge base in order to bring this to my patients.

A simple Biofeedback treatment consists of 45 - 50 minutes and is a means for patients to try an additional therapy prior to surgical intervention.

Look for this therapy in our office over the next six months and be sure to give us some feedback.

Larry Dossey, MD and the Future of Medicine

2008-12-01T14:29:00.003-07:00

The following is a reproduction of an interview with Larry Dossey, M.D. and is copied from his website http://www.dosseydossey.com/larry/qna.html . In this discussion Dr. Dossey discusses the periods in medical history and where we are today as a society. This discussion is from his book Reinventing Medicine

Era I, which can be called "mechanical medicine" and which began roughly in the 1860s, reflects the prevailing view that health and illness are totally physical in nature, and thus all therapies should be physical ones, such as surgical procedures or drugs. In Era I, the mind or consciousness is essentially equated with the functioning of the brain. Era II began to take shape in the period following World War II. Physicians began to realize, based on scientific evidence, that disease has a "psychosomatic" aspect: that emotions and feelings can influence the body's functions. Psychological stress, for example, can contribute to high blood pressure, heart attacks, and ulcers. This was a radical advance over Era I. The recently developing Era III goes even further by proposing that consciousness is not confined to one's individual body. Nonlocal mind -- mind that is boundless and unlimited - is the hallmark of Era III. An individual's mind may affect not just his or her body, but the body of another person at a distance, even when that distant individual is unaware of the effort. You can think of Era II as illustrating the personal effects of consciousness and Era III as illustrating the transpersonal effects of the mind. It's important to remember that these eras are not mutually exclusive; rather they coexist, overlap, and are used together, as when drugs are used with psychotherapy, and surgery is used with prayer.
What do these eras mean for the future of medicine? They can help us make sense of the confusion within medicine. By drawing attention to the effects of consciousness, they can help us move beyond the exclusive use of mechanical, physical measures in treating illness. The most interesting era, in my view, is Era III. The evidence supporting Era III implies that there are no boundaries to consciousness, that it is infinite in space and time. If our minds are unbounded, then they must unite or come together at some level. This means that in some sense we are literally one. The implications of this unity are profound. If our minds are connected, then we can, and do, share any and all experiences. All the joys and sorrows of life can be mutual affairs. This means we are never alone, which relieves the twin burdens of loneliness and isolation, two major factors in illness. The biggest payoff of Era III concerns our destiny. If our mind is nonlocal and boundless, then it is infinite in time. Therefore, the death of the body does not mean that consciousness ceases to exist; something about us endures. Era III, therefore, carries with it the promise of immortality, which is a cure for the "disease" that has caused more suffering for humans than any other: the fear of death.
How did you become interested in the effects of prayer? I grew up in a deeply religious environment in central Texas, where people prayed all the time; but I threw religion overboard when I went off to college and fell in love with science. I had no interest in prayer again until, during my practice of internal medicine, I occasionally began to bump into patients who had horrible diseases and who received no medical treatment - yet their illnesses went away following prayer. One patient I encountered during my first year in medical practice had terminal lung cancer for which no treatment was given; members of his church prayed nonstop for him and the cancer totally disappeared. I did not take these cases seriously, however, until the mid-80s, when I discovered the existence of scientific studies, dealing with humans and animals, showing the effects of prayer. After years spent researching this evidence, I became convinced that it is one of the best-kept secrets in medicine.
Can you cite specific research that supports your theory that prayer can help people heal? In 1998, Dr. Elisabeth Targ and her colleagues at California Pacific Medical Center in San Francisco, conducted a controlled, double-blind study of the effects of "distant healing," or prayer, on patients with advanced AIDS. Those patients receiving prayer survived in greater numbers, got sick less often, and recovered faster than those not receiving prayer. Prayer, in this study, looked like a medical breakthrough. In 1988, Dr. Randolph Byrd conducted a similar study at San Francisco General Hospital involving patients with heart attack or severe chest pain. He found that patients receiving prayer did much better clinically than those who did not. Currently, Dr. Mitchell Krucoff at Duke University Medical Center in Durham, North Carolina, is studying the effects of prayer on patients undergoing cardiac procedures such as catheterization and angioplasty. Patients receiving prayer have up to 100% fewer side effects from these procedures than people not prayed for. These are impressive double-blind studies, meaning that no one knows who is receiving prayer and who isn't. This eliminates or at least reduces the placebo effect, which is the power of suggestion or positive thinking. However, the studies I find most impressive are not done on humans. For example, when bacteria are prayed for, they tend to grow faster; when seeds are prayed for, they tend to germinate quicker; when wounded mice are prayed for, they tend to heal faster. I like these studies because they can be done with great precision, and they eliminate all effects of suggestion and positive thinking, since we can be sure the effects aren't due to the placebo effect. Mice, seeds, and microbes presumably don't think positively!
How do you see these concepts being incorporated into the current medical model?My wife and I were recently invited to consult with a large hospital in a major city. The CEO and a few physicians on the staff had become aware of the evidence supporting the health effects of religious devotion and prayer. How, they asked, should they respond to this evidence? Should they relegate responsibility to the clergy or to hospital chaplains? Should the physicians and nurses play an active role? A meeting was held that involved prominent leaders of the community. One woman stated, "If I were sick and came to this hospital, and you didn't offer me some form of spiritual support, I would be very angry!"This illustrates the situation our healing institutions face. The public, by and large, wants spiritual support to be available. A survey on the East Coast found that 75% of hospitalized patients believed their doctor should be concerned about their spiritual welfare; and 50% wanted their physician to pray not only for them, but with them. In response to the evidence showing a positive role of prayer and religious practices on health, nearly 50 medical schools currently offer courses in this area. The fact that our young doctors are now learning about these issues is an important indicator of where we are headed.But Era III interventions do not have to be physically located in hospitals. Recall that prayer and positive intentions are nonlocal; they work at a distance. Evidence suggests that they are as effective from the other side of the earth as at the bedside. This means that lay groups, off site, can successfully employ these methods; we don't have to depend on doctors and hospitals to provide them. Even so, I do believe physicians should take a greater lead in Era III medicine. Perhaps they may choose to pray for their patients. Or, at least, they might mention the importance of these factors, which could encourage patients to "cover their spiritual bases" in their own ways: for example, asking friends to pray for them or placing their names on various prayer lists in the community. The important thing is to honor the data supporting the benefits of spirituality in health, instead of continuing to ignore them. As we move forward, however, we must be very careful not to use this evidence as a pretext for pushing our private religious views onto people who are sick. I have seen a few examples of shameless evangelizing during illness, which I deplore. Above all, we must avoid making people feel as if they are spiritual failures if they get sick or don't heal, as if illness were punishment for sin.
What sort of reactions have your ideas met with in the medical establishment and among practitioners of different religions? There is intense interest among physicians. I cannot keep up with the invitations to speak about these issues at medical schools and hospitals. This is a dramatic change from five years ago, reflecting a growing acknowledgment of the evidence that supports a role for spirituality in health. Of course, there are a few doctors who think this wrong, who believe we're trying to drag medicine back into the Dark Ages, but this is a minority point of view. Modern medicine is one of the most spiritually malnourished professions that has ever existed. Doctors need their spiritual needs to be met, just like anyone else. This is another reason most physicians are sympathetic to these developments. The response from nurses tends to be, "What took you so long?" Nurses, by and large, understand intuitively the role of spirituality in healing. I am immensely grateful for their support. The response of the theological community is 95% positive, although a small minority doesn't like that the experiments show that the prayers of all religions appear to be effective.
What is the current attitude about alternative medicine held by the orthodox medical community? How is the popularity of alternatives affecting the mainstream? Surveys show that a large majority of conventional physicians are interested in alternative therapies and want to know more about them. As an indicator of this widespread interest, the Journal of the American Medical Association devoted a special issue to alternative medicine in 1998; and the great majority of the nation's 125 medical schools have courses in alternative therapies. Most physicians are stunned by the extent to which their patients have responded to alternative therapies. Nearly half of adults in the US seek out some type of alternative therapy every year; this exceeds the combined number of office visits to family doctors, internists, pediatricians, and gynecologists. Currently, most physicians are trying to understand why this is happening, and this is prompting a healthy reexamination of medicine in general.
What is the most important issue in health care today? What will the hospital look like in the future? What will training be like? The major challenge we face is how to spiritualize and humanize medicine, how to infuse it with a compassionate quality that answers to our inner needs as well as to the needs of our physical bodies. The good news is that this challenge is being met. In the future, high-tech medicine will remain with us and will become even more prominent. But in addition, psychological and spiritual approaches to healing will assume a substantial position. Healers will take their places in surgery suites, coronary care units, and emergency rooms, as they are already beginning to do in some hospitals. As a result, it will feel different to be a patient. One will know that "the system" cares about the soul as well as the body. Fantasy? Hardly. These changes are already penetrating some of the major hospitals in the country.
What applications, beyond medical practice, can Era III thinking have, in our culture at large and in our private lives? The foundation of Era III is nonlocal mind -- mind that is infinite, eternal, immortal. As nonlocal mind becomes a living reality for more people, we could become a kinder, gentler culture. Nonlocal mind leads to what I call the Golden Rule of Era III: "Do good unto others because they are you!" Why? Because, as I said earlier, nonlocal mind is unlimited and boundless, which means that minds can't be walled off from each other. In some sense, at some level, we are each other. Taking nonlocal mind seriously can, as I describe in Reinventing Medicine, widen the dimensions of the consciousness. We can tap into sources of wisdom beyond ourselves and beyond the present. Creative breakthroughs and prophetic knowing become ordinary in the context of nonlocal mind. Empathy and compassion flower as a result of our felt linkage with one another. And the awareness of immortality, as I've described, takes the pressure off living and dying. This will not happen automatically, however. We have to do our share and set our biases and prejudices aside. These are urgent matters. As Andre Malraux said, "The twenty-first century will be spiritual or it will not be at all."

The Current State of Medical Care

2008-11-30T11:54:00.003-07:00

A recent study of over 1,000 family practitioners stated that close to 70% of primary care providers would be either retiring or leaving medical care within the next 5 years. While this is disturbing, what I found more disturbing is the responses to this story on google. Most, if not all of the responses were blasting the medical professionals for being whiners and for making too much money. Is that what patients are truly upset about is that their doctor is making too much money. Obviously, people are entitled to their belief systems, but what a horrible system in which to operate.

Doctors are whiners? The real reason that I will see 44-50 patients per day is because people call my office and need to be seen; does this make the patient a whiner? I would say no, this means that the patient feels the need to see a doctor and on our end, we try to work them in so that this service can be provided. In a socialized format, this phone call to be seen on the same day will be a thing of the past, and with lower numbers of doctors practicing medicine, there will be less appointments.

I am not starving to death and I never have complained about my income. I can tell you that I have spent 4 years in medical school, 4 years in residency, and 2 years in fellowship (all after college), to get where I am today, and yet, there seems to be a culture in this country that 10 years of postgraduate work should not be monetarily rewarded, or if one makes money then this makes them a greedy or bad person somehow. I am always fascinated how people make money in this country. I know many people that did not graduate from college that are making more than me, and I do not belabor them; I wonder how they did it.

Medical reimbursements have not increased substantially in the last 10+ years, while hard costs for running an office, employee payroll, medical malpractice, and cost of equipment have increased substantially. The man cost at my office is payroll and employee benefits and this increases yearly. The reason for this increase is that we have wonderful employees and we pay them in order to keep them. My main postulate is that we take care of people. We make money as physicians and we give money back. The truth of the matter is that money seems to be how people are judged in our society, and I am not sure this is a true measure of a person's worth.

Medical care in this country is beyond sick, it is in the throes of death and will not be recovering. Who is to blame?

The doctors for making too much money? If that were the case then why would more than 70% of primary care physicians be leaving medicine in the next few years. I would think that the promise of a lucrative income would keep them plugging away. The truth is that the work loads and patient dissatisfaction with their own casts is pushing physicians out of medicine. The volume of paperwork is a monster that has consumed many medical practices and this is worsening. Money is not worth the paper it is printed on....literally. Physicians don't make too much money, they are burned out trying to get the payments from insurance and buried under mountains of paperwork.
The patients for not taking better care of themselves? Unfortunately, one of the reasons we are one of the least healthy countries in the world is not because of our medicine, it is because of our nutrition. When drive through burgers are cheaper than fresh produce, this is a problem. When the main portion of a diet are aspartame, corn syrup, and meat byproducts (whatever those are), then this is a problem. We have expensive medical care, no doubt, but we use it too much. Patients are plagued by rising medical insurance costs and many of them have no idea what their plans even cover. Medical insurance is only good in this country if you don't get sick. Patients should be rewarded for being the right weight and for being healthy. Health insurance should also be there for patients when they need it.
Frivolous lawsuits. While lawsuits are definitely warranted in cases of gross negligence, the amount of frivilous lawsuits yearly is laughable. Similar to the woman that burned herself on coffee from McDonalds and won multiple millions of dollars (now we have warnings that our coffee is hot) for something that seemed common sense. We want to blame someone when complications happen. Unfortunately, medical care is not perfect, because the people giving the care are human. We have a robot for surgery. The robot is still run by a human being.
Insurance companies. You pay the premiums, they deny procedures. You drive out of the state where you reside and your coverage stays behind (ridiculous). Have you ever really sat down and read your policy? Do you know what they pay for if you go to the emergency room? Do you know what your copay is for a visit at the doctor's office. Did you know that copays and premiums have been skyrocketing for years and reimbursements for procedures and physician visits have not........where is this money going? If the insurance companies would spend more time paying for legitimate healthcare that you have subsidized with your premium payments, rather than spending money on trying to find a reason for denial, it would more than likely save money.

The main point of this essay, is to point out the fact that our medial system is ready to die and I think we need to let it go. I might get raked over the coals by colleagues for this, but if Obama wants to socialize medicine, I say let it be. I am very suspicious that socialized medicine will work and I am not for paying higher taxes, but I think the current system is disgusting. If socialized medicine means that patients are happy, this in turn will truly help me sleep better at night. I think consumers should be happy with the product they receive, and while I feel that physicians are doing the best we can, the patients are not happy. Physicians let managed care take over in the 80's and we should jump on the grenade created by the current state of affairs. Medicine is controlled by bureaucracies and socialized medicine would be the biggest bureaucracy of them all.

The question would be, once medicine is controlled by Uncle Sam, will we be a healthier nation? Will we be able to regulate something that has been removed from the public sector. How many jobs will be lost just in the private insurance sector? These are questions that need to be evaluated.

Suzanne Somers and Medicine?

2008-10-01T18:52:00.003-07:00

In the words of text messagers around the world, I have to say, OMG.

In the last few weeks, our office has been deluged with people calling from different states (not consciousness) asking for appointments with me for hormone replacement therapy. Obviously, I am a good choice for this since I am a gynecologist. There are many practitioners out there that charge cash for labs, medicines, and time; occasionally, these visits with labs and medications take cost up to $2000. I charge the insurance company for the visit. I prescribe synthetic hormones, but I would say that 75% of my menopause practice is women that desire bioidentical hormone replacement.

In steps the lovely Suzanne Somers.

Love or hate her, she has begun to make an impression on the menopausal women around the country. She has recently released a new bestseller called, "Breakthrough" and it seems as though I am listed in her book. I did not write a chapter or doing anything of that magnitude,but I am listed in the back of her book, under "resources" and my phone has been ringing off the hook.

Honestly, I have no idea how I was selected, but at times it is nice. As stated, I do not have enough appointments for all of these women that are dealing with the quiet state of menopause, but I will be making time if possible.

Over the next few weeks I am going to be undertaking an explanation of bio-identical hormone replacement in order to describe to the masses a physician's take on the concept; keep in mind that I am on no one's payroll, unlike many of my colleagues that downplay the significance of hormones and HRT.

The first caveat when looking at a study for HRT; is the study being funded by Wyeth-Ayerst or Pfizer. If the studies are being funded by big pharmacy then it is hard to believe that the experiment is without bias. Big pharmacy spends millions on convincing patients and doctors that their drugs are better than other things out there. Just watch Lifetime television for more than ten minutes to see how many pharmaceutical commercials are geared towards women with menopause or depression.

Sit tight, we're in for a bumpy ride.

Next week - Estriol, estradiol, and estrone.

Cleanse Thyself - Day 13

2008-08-24T10:08:00.002-07:00

So it's been a while since I last posted and maybe some were to beginning to wonder if I was either so debilitated from a lack of food or maybe just fell off the wagon. Well I am here to report that I have completed day 13 on the fast and cleanse. It has come with sacrifice, headaches, cravings, discovery of some new foods, and psychological warfare with myself.

I must confess that on day 7 there was a fall from grace. You see, we had an office family picnic at our house and I was left to cook the hamburgers and hot dogs. Needless to say, I secretly ate a hamburger and washed it down with a margarita. For some this sounds like the beginning of a nice evening, but for me it was like being in heaven for a few minutes. Since y fall I have been back on the cleanse.

Overall, my abdomen has flattened substantially. I am also beginning to discover that I am not hungry. I still want food because I am craving something, but when I become mindful about why I want it, I discover that I am not really hungry; I just want to eat. I think this is the behavior that has gotten me into trouble in the past. This discovery could even potentially transfer into other areas of my life. You see, this cleanse has been a psychological battle with myself. I have to tell myself NO. This is not easy to do for me and I assume that it is not easy for others out there reading this as well.

I am entering the third week. I am keeping my fingers crossed.

Weight - 202

Total Lost - 9.5 lbs in 13 days

Cleanse Thyself - Day 3

2008-08-13T12:54:00.002-07:00

Ok, so the first three days have been a bit brutal. I have been eating my fair share of fruits and vegtables, but my brain feels as though I am starving to death. I realize that I am not when I look into the mirror, but it sure feels that way. I think about food a lot and this has reinforced my beliefs that I use eating as a comfort. When you strip that comfort away, you then have to rely on self.

I have had headaches and stomach gurglings. My liver must be releasing large amounts of stored glycogen because I am in the bathroom urinating all the time.

Lastly, I have discovered a beautiful foodstuff called quinoa that is a grain from South America. You soak it in water for a few hours to break up the saponins and then boil it up. Covered with raw honey or agave nectar it is wonderful.

Weight - 207
Total Lost 4 lbs in 3 days

Cleanse Thyself - Day 1

2008-08-11T21:47:00.004-07:00

I have decided to cleanse and try to lose some weight in the process. My dietary habits have become horrible and although I try to practice yoga at least two times per week, I find myself run down and tired constantly.

My wife and I have decided to do a raw food diet (of which I know little) and use herbal supplements. I am not going to mention the program that we have chosen as I am not certain I want to endorse any particular product, but I have decided to put my journey out there on the web. I am going to try to do this daily post for the next 28 days (forgive me if I miss a day or two). I am not certain what to expect, and at this point I am happy that I have completed one day.

Today was tough. I found myself reaching for Twizzlers and salivating over a piece of wheat bread. The main thing I discovered is that I am not a mindful eater. I know this because I found myself reaching for things and then having to catch myself. I would venture to say that many of us have the same issue. My foods today consisted of vegetable juice, blueberries, raspberries, bananas, and leafy greens. I have not had any particular cravings, but I have been hungry at times. As I am trying to be more mindful, when the hunger hits I am asking myself why and what I want to eat. It has been rather enlightening. My reason for wanting to eat most foods is simple, "because I want it". This is obviously not a good reason. Today I had a pretty good headache around 2:00pm and I am sure I didn't drink enough water, because I am not good a drinking water.

I will be posting my weight at the end of each post and total pounds lost.

Weight - 211 lbs

Total lost - 0 (day one)

Wish me luck

Postpartum Depression - Losing Your Soul

2008-08-02T22:24:00.003-07:00

In the past few months I have seen a few women with postpartum depression. Despite Tom Cruises' beliefs, this is an actual process that can overwhelm the new mother. Many times these poor women feel isolated and alone. The feelings range from simple postpartum blues to severe depression where there can even be ideations of suicide and/or hurting the baby. Obviously in the even of the latter, I would encourage the patient and her family to either call 911 or proceed directly to an emergency room so that the patient can be evaluated and protected.

I am not writing this post to bore you with the potential hormonal influences or the DSM-IV definition of postpartum depression simply because the women that have this issue, at times, defy the definitions and the categories.

In the world of shamanic practice, there is a ritual and ceremony for something called soul retrieval. Shamans believe that a portion of the soul is able to leave the body. There are various reasons that one can experience soul loss; childhood traumas, accidents, sexual abuse, and loss of a loved one. Indigenous healers also conjecture that a mother may give a part of her soul to her newborn baby in order to protect her infant.

The reason that I bring up soul loss in this discussion is because I think that in two of my most recent cases, the postpartum depression was a sign of a soul loss in that woman's life. They were exposed to childhoods that were less than nuturing and where they were told that they would never amount to anything. The loss suffered when the current mother was a child is a piece of that past/soul that will not return on its own, but during childbirth and the trauma of becoming a new mother, I wonder if that piece of soul memory comes flooding back to the patient. Since the soul piece/memory does not know how to incorporate back into this new adult being, it becomes an anhedonia or a depression.

Is this something that medication would fix. In my opinion, no, but it could help the lability of the mood. I liken medications for depression to a new car. It sure looks good sitting there in your driveway and people may think, "wow, what a beautiful vehicle", but it really doesn't go anywhere without gasoline. The gasoline in my opinion is therapy. Can people break free of depression with just medication? Yes. Can people break free of depression with just therapy? Yes. My course of action is to usually start a medication if the patient is interested, but I prefer to get them in with a therapist. The type of therapist depends on the patient.

In one particular case, the patient was exhibiting anger, rage, and somatic pain in her back and on the right side of her body. I thought she may do well with a psychologist that specialized in somatics. I recommended that she see a woman that utilizes a method called Rubenfeld Synergy. The principles of Rubenfeld Synergy are as follows:

Each individual is unique
The body, mind, spirit, and emotion are all interrelated
Awareness is the first key to change
Change occurs in the present moment
The body is a metaphor
The body tells the truth
The body is the sanctuary of the soul
Humor can lighten and heal
Altered states of consciousness can aid healing
Reflecting clients verbal expressions validates their feeling

Here is a link the Rubenfeld Synergy Standard of Practice

The point I was hoping to make is that postpartum depression is real and devastating. The new mother is grappling with the feelings that she may not like her baby even though she feels the love. She then must deal with the potential judgement that she knows others may have for her if she speaks about her feelings. This is indeed a patient that is isolated.

The best thing you can do for a friend or loved one that you feel may be depressed is to have them see a healthcare professional. Hopefully, the healthcare profession will look beyond the medications and treat the soul as well. You see, the medications will not bring back or repair any memories that have been created in the past. They may assist the provider to stabilize the chemicals in the brain, but if the patient was abandoned by her own mother when she was young a pill may no be the answer.

Depression is incapacitating and devastating. Postpartum blues happen within the first 30 days after birth and they are transient. Consider seeing a mental health care professional or asking your primary doctor to refer you to someone with the training to help.

Remember, your beautiful car needs gas to run, even if the price of gas is expensive.

When is it too much?

2008-06-23T19:14:00.002-07:00

Just a short post. I have been too concerned lately with posting the perfect thing and this has caused a writer's block of sorts. I am going to go over things that I see in my clinic a discuss them as brief posts. I wanted to do this in a way to bridge the patients that are pursuing purely alternative means with the allopathic physicians that need to have everything proved with science.

I have had a rash (no pun) of patients lately that present saying they have systemic yeast infections. Yeast is a fungus that normally populates the GI tract, skin, and genitalia. It is when the yeast has overgrown that one sees symptoms. When someone comes to a physician and states that they have a systemic yeast infection, most physicians would ask how you came about with that diagnosis. In the patients that I have seen there is no diagnostic test, this is simply something that has been dictated to them by an alternative practitioner. Personally, I feel there needs to be some sort of testing that proves such a large diagnosis. To give a patient this diagnosis without said proof would be unethical. When I hear of a systemic yeast infection, I think of someone that has a compromised immune system by some sort of chronic debilitating illness like HIV.

A common website states that systemic yeast can cause the following illnesses:

arthritis

gout

Chronic fatigue syndrome

fibromyalgia

high cholesterol

crohns disease

Irritable bowel syndrome

asthma

allergies

acid reflux

arteriosclerosis

psoriasis

eczema

roscea

hives

acne

dandruff

depression

Obviously these diseases can be caused by more common things like poor diet, obesity, and genetics. In my search for the treatment of systemic yeast infections I was unable to find a website or office that was not selling some sort of cure. Keep in mind that yeast is a normal part of our flora and thus to kill it seems ridiculous. It is supposed to be there in small amounts and thus one should expect to have yeast. If there is a test that you mail in that shows you have yeast , then you should simply feel as though you have normal flora on your skin or mouth. It is when you have symptoms and are diagnosed with testing that the infection could be treated.

I am not opposed to things such has nutriceuticals and tea tree oil to treat yeast infections if they are diagnosed, but you should have them tested after treatment to see if the yeast has resolved. Usually, treatment is done to decrease the amount of yeast to levels that the immune system can treat on its own.

The moral of the story. Get the diagnosis from a reputable testing method. If you want to try something alternative to treat the yeast, then call an integrative physician and ask our options before spending hundreds of dollars on colon cleanses and probiotics. We are here to work together.

Medical Materialism

2008-05-19T18:10:00.001-07:00

I have written this paper and hypothetical study, and I am currently searching to have it published. I thought I would post it here for comments.

Medical Materialism:

Exploring the allopathic paradigm through shamanic practices

Shawn Tassone, M.D.

Introduction

Western medical practice has become a struggle for survival. Physicians are combating the rising costs of managing offices, while the specters of malpractice insurance, combined with decreasing reimbursements are leaving physicians and their patients disillusioned in a fractured system. “Our bureaucratized and materialistic medicine – this mechanical model with an active therapist and a passive patient that reduces the patient to an object and relegates healing to the long corridors of the hospital has failed.” (Kalweit, 1987, p.2). Western medicine has lost its roots, and in so doing, has become devoid of the natural processes on which it was founded. The care of the patient and community has been replaced with business reports and evidence based medicine (Block, 2007). In fact, many western medical societies have gone so far as to state that there is no place for religion or spirituality in medicine (p.9). The concept that medical practice has become pure science has completely removed spiritual or transpersonal experiences from the ability of the healer. Individuals who have wrung spirituality out of medical practice in the name of scientific exploration state that there is no place in medicine for spirituality and are thus committing medicine to the pre-trans fallacy (Wilber, 1983). Within the confines of the Pre/Trans Fallacy Wilber makes the argument that scientific or medical materialists assume that human beings do not have access to transpersonal experiences. “Once this confusion occurs – the confusion of “pre” and “trans” – then one of two things inevitably happens: the transitional realms are reduced to prepersonal status, or the prerational realms are elevated to transrational glory” (Wilber, 1999, p.333). Thus peak experiences or extraordinary healings achieved by shamanic practitioners are reduced to scientific relationships. These medical materialists have, for centuries, attempted to explain the healings and psychopomp of saints, mystics, and shamans as simply reactions in the human brain to external stimuli.

Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic. It snuffs out Saint Teresa as an hysteric Saint Francis of Assisi as a hereditary degenerate. (James, 2002, p.16).

Indigenous shamanic practitioners on the other hand practice healing with an eye towards imagery and community. (Achterberg, 1985) In his monumental work Shamanism: Archaic techniques of Ecstasy, Mircae Eliade discusses the three stages of becoming a shaman: election, instruction, and initiation. Michael Samuels, M.D., has also stated that shamanism has a fourth stage, the practice of shamanism (Samuels, p. 15). The calling and election of a healer is the stage of the process that stems from the family and the community. Allopathic physicians have similar stages of development; the calling to become a physician is the first stage, followed by the structured teaching of medical school, the initiation of residency, and finally the practice of medicine. In exploring the similarities between allopathic medicine and shamanic practice I will emphasize the call to be a healer.

Is there a reason that one is called to the practice of medicine? Like the indigenous shaman, there are many reasons one receives the call. Whether one is a healer in the allopathic framework or based in the imagery of the shamanic states of consciousness, there is a healing that is taking place between the healer and the patient. The premise of this article is that allopathic physicians share the calling to become a healer with that of the indigenous shaman. While the mechanisms and the practice of medicine will differ from country to country, the calling to become a healer has similar roots. The roots of the calling to become a shaman are the hereditary transmission of the shamanic profession, spontaneous vocation, or the response to the prompting of one’s own free will or the will of the clan (Eliade, p. 13). The calling and election of an allopathic physician is also deeply rooted in the ancestral transmission, spontaneous call, or by the needs of the community. I hope to bring shamanic ritual and healing imagery back into advanced Western medical practice by showing that the healing call for both shaman an medical doctor is based on similar patterns. Bringing medical practice back to its shamanic roots can reinstate the spiritual practice currently lacking in medicine. This despiritualized state is contributing to many physicians closing their doors and retiring or changing professions. The call to become a shaman, on the other hand, is a life long commitment.

Stages of Shamanic Training

As stated earlier, the stages of shamanic training are the calling, instruction, initiation, and ultimately shamanic practice itself. It would be my assumption that one could compare the levels of allopathic medical training with shamanic healing and find similarities and differences. In this paper I will compare medical training with the call to become a shaman. I will briefly describe the four stages of shamanism.

Shamanic Calling and Election

In many indigenous cultures, shamanism is a hereditary practice and can be transmitted along male or female lineage. Within many of these cultures, even when the shaman is born into a lineage there are gifts from spirits or gods that instruct the future shaman through dreams and visions (Mikhailowski, 1894). Those who have the calling based on familial transcendence will have a different course from those that are called based on vocation or those that are asked by the community. Other types of callings are illness and tragic life events. It has been proposed that an individual who experiences severe illness are merely being prepared to become a shamanic practitioner, and that by becoming the wounded healer they are preparing themselves for the practice of becoming a shaman (Halifax, 1991).

Shamanic Education and Training

For the shaman, the process of training occurs over many years or a lifetime. The training may begin in young adulthood and continues through experiences in nature and solitude, the teachings of elders, or by apprenticeship to a shaman. Among the Zulus there are twelve stages of training, and the Blackfoot novice must pass through seven “tents” to become a fully accomplished medicine man (Kalweit, p.20). Exposure to severe elements or situations is utilized in certain cultures. Japanese medicine men are made to stand under cold waterfalls or immersion in cold water intermittently for 100 days. (Blacker, 1975). The basics of education in the ways of shamanism, or that of a medicine man, is the transmission of knowledge and the ritualistic tools that have been either orally or physically transmitted throughout generations.

Shamanic Initiation

Shamanic initiations vary from culture to culture and can occur as part of a training series or spontaneously. Initiation creates shamans from those who have been called, and not all who are called will become shamans (Pratt, 2007). Four general forms of initiation have been described: traditional or cultural, instantaneous, wounded healer, and dismemberment (p. 227-229). Traditional initiation is the ordered progression that is most similar to medical residency, where the shaman will go through stages. Instantaneous initiation can occur with near death experiences. The wounded healer may have physical, emotional, or mental challenges that result in an insight or awareness that comes when they have surrendered to the process. Dismemberment or spiritual dismemberment occurs within the confines of shamanic states of consciousness. As stated above, the initiation of the shaman is irreversible, whereas that of an allopathic physician is terrestrial.

Shamanic Practice

The Western physician is an active healer in the sense that they diagnose and treat with the patient following instructions. The shamanic practitioner is a healer who becomes a passive participant with an active patient; the patient is simply guided in the direction of the healing. This practitioner now has mastered control of themselves, has become an advocate for the patient between the worlds of spirit and physicality, and they are participants in the community’s need to heal.

Stages of Allopathic Medical Training

The many rigors of allopathic medical training have similarities to the shamanic practice. There is the calling to become a physician, the education and initiation, and finally, the practice of medicine.

The Calling and Election of the Physician

The multitude of applicants to medical schools has remained stable over the last five years according to reports from the Association of American Medical Colleges (AAMC). The reasons behind the quest to become a physician are as multiple as the applicants. The percentages for genders are fairly equal according to the AAMC’s Applicants and Matriculants Data for 2007. This data is obviously not a representation of the American community as a whole and this represents a discord with shamanistic practice as most shamans are pulled or chosen from their community. Physicians may not represent the community where they ultimately practice. Medical students are groomed by their parents, have desires for stable incomes, in helping the human condition, and ultimately are drawn to the field because of the lure of healing.

Medical Education and Training

Medical training is also a lifelong process that begins in medical school. The educational phase of medical school is followed by the initiatory phases of residency, and the growth of private practice. The education received by medical students is similar to the shamanic practitioner, as one cannot practice healing without passing further tests and initiations. One receives a degree upon graduation, but this does not confer the power to practice medicine in Western cultures or shamanic cultures. In Western culture, after completing medical school, one must obtain a medical license after completing multiple exams and a minimum number of years in graduate education (“Anonymous”, 2000). In union with shamanic training, the allopathic healer learns through ceremony and ritual. One of the most prevalent learning rituals is that of the surgical suite. The allopathic trainee enters the healing theater of the surgical suite. The patient has instructions to fast before the surgical ritual, and at times the physician is without food due to laborious schedules. The room itself is structured with the patient at the center lying with outstretched arms in a Christ-like posture while the room is continuously sanctified with air filters. The attending physician will bring the initiate into the surgical ceremony after they have cleaned and garbed in traditional surgical gowns, and for many years the procedure will be performed with the residents and medical students simply visualizing the teacher.

Allopathic Initiations

Similar to the shamanic initiation, the physician will be transformed based on cultural norms. There are also practitioners that are called and initiated based on their own wounds; occasionally those with personal wounds will choose the profession in order to assist others with the same disease (Jackson, 2001). Traditional initiation is the residential format that medical students enter upon receiving a degree. The residency is based on the physician’s core needs and what most resonates with them as healers. The residency will last from three to five years and is a graded system with more responsibility based on the ability of the provider. The major difference in the initiatory processes of shaman and physician is the fact that shaman are called for life. Recently, physicians are leaving medical practice or changing fields due to socioeconomic and cultural pressures.

Allopathic Medical Practice

In my own experience, the practice of medicine is a continuation of the process in medical training. Unlike the indigenous shaman who usually practices alone in a community, the physician will join a larger group of healers. This practice is now without the supervision of the initiatory processes of residency, however, the allopathic healer is in a sub-clinical phase at this point until they become board certified. This certification is a process by which the elder healers confer the rites of healing upon the initiate physician. Of note, shamanic practice also undergoes a form or board certification. “Before the shaman-in-training of the Tenino, of northern Oregon, can begin his practice, he must prove his gifts before a committee of older shamans” (Murdock, 1965).

Methods

The purpose of this investigation is to evaluate the healing call of medical students and residents. These students were part of an integrative medicine elective sponsored by the University of Arizona. Throughout the month students were exposed to different healing practices and modalities of healing that differ from the allopathic model. The students and residents that participated in this elective were in allopathic medical training programs, but open towards different healing modalities. At the end of this elective rotation, five students and three residents were taken to Sedona, Arizona. In Sedona they were exposed to the Huichol healing traditions through the teachings of James Endredy author of Ecoshamanism and Beyond 2012.

The day consisted of exploration of ancient ruins in the red rocks surrounding Sedona while performing healing ceremonies with indigenous techniques. The students and residents were invited to not only become the patient in the ceremony, but to heal and bless their colleagues as well. At the end of the healing ceremonies there also time for a traditional Huichol fire ceremony where the participants were invited to speak to the fire and participate in ritualistic dancing. Each participant was encouraged to discuss with the fire their past and future. This initiation with fire captured the spirit and essence of the place, and allowed the participant to explore the spiritual essence within themselves. The purpose of exploration with the earth and fire is to categorize and bring to light the initiation. By bringing this ceremony back into the conscious thought of the students and residents, it was the feeling that this may ignite memory of their call to become healers. The sacred fire as described by Endredy allows a primal connection that creates a holistic state of consciousness with the power to advise, heal, and nurture us on our anointed path (Endredy, 2007, p. 311). It was after the exposure to the elements and the surrounded by the blessings of the earth, and fellow colleagues that the students were asked to privately reflect on their call to be a healer. The students were asked why they decided to follow the path to become an allopathic healer. Students and residents were told that their responses would be handled as a group and that there would be anonymity not only within the data but also within the group. There were four medical students from different parts of the United States and one from Canada; all were in their last year of training. There were three residents that were also in their last year of training and from different areas of the United States. All of the participants had spent at least three weeks in each other’s companionship and thus they were comfortable sharing personal reflection.

Results

Five of the participants claimed that they had either one or both parents that were physicians. Some of these responders claimed that they were not certain how much their parents played a role in them becoming a healer, but that there was definitely lineage involved in their decision. The remaining three were called by vocation. Healing practice called to them and they were uncertain as to the cause. None of the respondents claimed that an illness had been the reason for them to go into medical practice; this was neither their own illness nor that of a family member. More than the nature of their written responses was that of my observations during the course of their shamanic work. Throughout the day there was a distinct decrease in the amount of resistance of the students and residents to the ideas of shamanic practice. Most of the respondents claimed that they were skeptical of shamanic practice prior to the exposure, but all stated that they felt an increased awareness of themselves and their surroundings at the end of the exercise. There was a general cohesiveness among the group as a whole that seemed to culminate when they performed healing rituals on each other. During the healing ceremony each student called upon the ancient ones; Tate Wari (Grandfather Fire), Takutsi Nakawey (Grandmother Growth), Kauyumari (Deer Spirit), and Tatei Yurianaka (Mother Earth). Each participant was also instructed to let the healing ceremony become a free flowing instrument guided by him or her. They were asked to invite the spirits to become part of the healing ceremony to help empower each participant, their families, and the universe.

During the healing ceremony, participants reported emotions such as love, anxiety, fear, anger, and sadness. Many of the participants, as the healing was being given, claimed they were able to sense the immediate surroundings more easily. There was a consensus of becoming more in tune with one’s body and that hearing and touch were increased. They were also able to feel emotions from the officiator and the group surrounding them.

Final analysis reported through written communication showed that each participant felt more in touch with the healing practice of allopathic medicine. This was not reported as an opening to shamanic practice as much as it was an opening to the healing practice for which they were trained.

Conclusion

Medical students and residents become wounded healers as they train and practice medicine. They are wounded by long hours and a disconnection with the basic health, healing, and holiness that medicine has offered them. “Healing itself has little to do with the surgeon’s scalpel or antisepsis. Wholesomeness and basic health are attained, rather, only through inner purification.” (Kalweit, p. 1). Through the process of shamanic ritual, medical students and residents may learn that healing is more for the community first, then the person and finally the illness itself (p.1). This shamanic medical model is a reversal of the allopathic model that focuses on the illness in order to heal the person and thus the community. Materialistic medicine is not humane medicine. The humane healing practitioner becomes a passive participant in the healing process and acts in accord with the patient’s destiny and individual intent (Meyer, 1996). I have attempted to show a correlation between the call and initiation to becoming a shaman and the call and training of an allopathic practitioner. Exposure to the healing shamanic arts opens the allopathic healer to their own inner healing. The training for the shaman is one that involves the community. Medical schools have an important role in reducing the isolation of their students from alternative health beliefs like shamanism that are a part of our community (Poland-Laken, 1995). The call to be a shamanic healer is similar to that of the allopathic physician. At some point in the medical training, students and residents lose their connection to the community where they reside. This disconnect or wounding can be healed, or the wound utilized, by bringing the trainee back to the shamanic roots of medical practice. Shamanic practice is the portal for recovery of the wounded healer. The realization of the call, and the wounds of the initiation can unfold into the power of the wounded healer.

“We could say, without too much exaggeration, that a good half of every treatment that probes at all deeply consists in the doctor’s examining himself, for only what he can put right in himself can he hope to put right in the patient. It is no loss either, if he feels that the patient is hitting him, or even scoring off him: It is his own hurt that gives the measure of his power to heal.” (Jung, 1951, para. 239.)

The call to heal comes from the familial bonds of the shaman-physician, the vocation, or the wounds of the past. In any case, it is the spiritual glue that provides these physicians with the ability to become healers. The continuation of spirituality in medicine is critical as a conduit to the process of the inner healing of the physician. The inner healing of the physician is a crucial aspect of bridging the gap with the community. Shamanic practice is the link that will bridge the gap between the wounded healer and the disembodied local and global community.

References

Achterberg, J. (1985). Imagery in Healing; Shamanism and Modern Medicine. Shambhala Publications Inc. Boston, MA.

Anonymous. (2000). “Your Doctor’s Education”. Journal of the American Medical Association, 284(9), 1198.

Association of American Medical Colleges. (2007, September 9). U.S. Medical School Applications and Matriculants by School, State of Legal Residence, and Sex Retrieved April 26, 2008, from http://www.aamc.org/data/facts/2007/2007school.htm

Blacker, C. (1975). The Catalpa Bow; A study of the shamanic practices of Japan. Ruskin House. London, England.

Block, M. (2008). Allopathic or Allopathetic Medicine? The impact of non-evidence based disciplines on allopathic medicine. Arizona Medical Association’s AzMedicine, 18, 8-9.

Eliade, M. (1992). Shamanism; Archaic techniques of ecstasy. Bollingen Series LXXVI. Princeton University Press. Princeton, N.J .

Endredy,J. (2007). Ecoshamanism: Sacred practices of unity, power & earth healing. Llewellyn Publications. Woodbury, MN.

Halifax, J. (1991). Shamanic Voices; A survey of visionary narratives. Penguin. New York, NY.

Jackson, S. (2001). Presidential Address: The Wounded Healer. Bulletin of the History of Medicine, 75(1), pp. 1-36.

James, W. (2002, Centenary Edition). The Varieties of Religious Experience; A study in human nature. Routledge. London, England.

Jung, C.G. (1951, Bollingen Series, XX). The Collected Works of CG Jung. Princeton University Press. Princeton, N.J.

Kalweit, H. (1987). Shamans, Healers, and Medicine Men. Shambhlala Publications, Inc. Boston, MA.

Meyer, F. (1996). Organ transplantation: Do we know what we are doing?. Journal of Anthroposophical Medicine, 13(3), 1996.

Mikhailowski, V.M., (1894). Shamanism in Siberia and European Russia, Being the Second Part of Shamanstvo. Journal of the Royal Anthropological Institute, 24, p. 60-100.

Murdock, G. (1965). Tenino Shamanism. Ethnology, 4, pp. 165-171.

Poland-Laken, M., Cosovic, S. (1995). The Journal of Alternative and Complementary Medicine, 1(1), 93-98.

Pratt, C. (2007). An Encyclopedia of Shamanism, Volume 1. The Rosen Publishing Group, Inc. New York, N.Y.

Samuels, M., Rockwood-Lane, M. (2003). Shaman Wisdom Shaman Healing; Deepen your ability to heal with visionary & spiritual tools & practices. John Wiley & Sons. Hoboken, N.J.

Wilber, K. (1999). The Collected Works of Ken Wilber, Volume III: A sociable god – eye to eye. Shambhala Publications Inc. Boston, MA.

The Changing Face of Medical Care

2008-05-06T23:51:00.003-07:00

How much time do you want to spend with your physician?

My guess would be more than 5-10 minutes. Sometimes I want to spend as little time as possible with my own physician, especially when she is telling me that I need to lose weight. The truth of the matter is that even in this instance, she really can only tell me to lose the weight, without really having the time to tell me how.

I liken the typical physician's office scheduling system to that air travel. First and foremost you are concerned that you get a ticket to get on the plane. In this case, that is calling the medical office to make the appointment. I have called many medical offices, even under the guise of being another physician, and have had 5-10 minute waits on the phone. Some offices have a message-on-hold or music, while others have simply, dead air. With the dead air, when you are put on hold, you often wonder if they have hung up on you but a afraid to hang up and call back, just in case you might be next in line on the phone tree.

Let's assume that you have your appointment. The next step in your medical travel is arriving at the airport (the office). In some instances you will receive a packet of material from the office ahead of time. Many offices are now on electronic medical records and have either bubble sheets or other forms of data entry. Some offices will have stations where patients have to enter their own data into the computers. This can be cumbersome for patients that are not tech savvy. We always want new patients to show up 15-30 minutes early so that you can fill out the appropriate paperwork (checking though security). Alas, a majority of patients will show up right on the appointment time and thus are 30 minutes late being seen (boarded). In rare instances, you will be told that you have simply lost your appointment (seat) and have been rescheduled to another day (flight). This keeps things running on time but can definitely leave you with a bitter taste in your mouth.

Just like real travel, you have to go into a physician appointment with an open mind and an open schedule. You always have to plan for the "what if". What if the doctor is running behind or gets called out to go deliver a baby. Try to be flexible and understanding. Personally, I hate running behind just as much as the patients are uncomfortable sitting in a awaiting room past their appointment time. It is helpful to realize that we are all on the same flight and hopefully we will all arrive at a common location. That place is the sanctum of you feeling as though you had your time with the doctor and had your questions and concerns answered. For some this may mean a 5 minute appointment, and for others it may mean much more.

The last comparison between airline travel and visiting a medical office is that of overbooking. We always have no-shows (people that are scheduled and confirmed, that simply do not show up). Physicians (I can't speak for pilots), also tend to feel as though they can, at times, do things that mere mortals cannot; like see two people at the same time and then see two more people simultaneously 10 minutes later. We also practice by the "what if". What if patients don't show up for their appointments? Do we overbook? Yes we do. The simple fact of the matter is that there are not enough physicians out there anymore, so we are trying to see more patients with less resources. We have co-pilots like nurse practitioners and physician assistants that extend us when we cannot be in two places at the same time. Some patients would rather see the physician, but many patients just want to be assured they are receiving quality health care and physician extenders are an excellent community resource.

So, the next time you are calling for an appointment at your physician's office, expect to be treated kindly and with compassion. Arrive at the appointment when expected with a good book and if there is a wait, understand that there may have been someone ahead of you that was given bad news or just had many questions. Mindfulness of others is an excellent practice. If you do not feel as though the wait was appropriate or the people scheduling were on par, then tell your physician. I listen to everything that is said by my patients because my practice is a reflection of me and how I present myself to my community.

There are two ends to a stethoscope. One heart at each end, offering healing and comfort in each direction.

Safe travels.

Prenatal Hypnosis and Birth Outcomes

2008-04-12T21:50:00.003-07:00

Recently, my wife and I had the pleasure of having dinner with Lewis Mehl-Madrona, MD, the author of "Coyote Medicine" and most recently "Narrative Medicine". During the course of the evening we had the opportunity of speaking with him about researched he conducted with patients on prenatal hypnosis and how it affected birth outcomes. I wanted to share the paper with you. Information is listed if you would like the study in its entirety.

This research was supported in part by Resources for World Health, Inc., San Francisco, California; the contributions of an anonymous individual private donor from Tucson, and by the United States Air Force. The opinions expressed herein are solely those of the author and do not reflect opinion or official policy of the United States Air Force or the Department of Defense.

Address communication and reprint requests to Dr. Mehl at the Center for Complementary Medicine, Shadyside Hospital, University of Pittsburgh Medical Center, 5230 Centre Ave., SON Bldg., Rm 216, Pittsburgh, PA 15232. Voice: 412-623-1365, fax: 412-623-1029. E-mail: madronalm@ssh.edu and/or mmadrona@aol.com.

ABSTRACT

Background: Prior research by the author showed that psychosocial factors distinguished abnormal from normal birth outcome. The purpose of this study was to determine if prenatal hypnosis could facilitate normal birth.
Methods:
Results: The use of hypnotherapy significantly inhibited negative emotional factors from being related to abnormal birth outcome.
Conclusions: Attention to reducing the impact of adverse psychosocial risk factors through the prenatal use of hypnosis did improve outcome.
INTRODUCTION

In these days of health care reform, an important opportunity exists to explore the utility of psychosocial interventions in improving birth outcome. These interventions are often less expensive than medical procedures and can be provided by non-physicians. One of these interventions is hypnosis.

Labor length and analgesic use have been reported to be decreased when hypnosis is done during pregnancy. [1] Anxiety about and during birth is decreased. [2] The incidence of postpartum depression is lessened.[3], [4] Increased self-confidence, increased calmness during labor, and easier transition into breast feeding has been described.[5]Decreased pain sensation has been reported.[6], [7], [8], [9], [10]Reductions have occurred in the number of complicated births.[11]Babies born have had higher Apgar scores.[12] Hypnosis subjects experienced greater belonging and security during labor, were less afraid of birth, and perceived birth more as a positive event.[13]Hypnosis helped women to be more relaxed during labor and birth, reduced hyperventilation, and increased feelings of participation and mastery.[14] A psychosocial intervention program that included hypnosis reduced the number of cesarean deliveries and oxytocin augmentations or inductions.[15]

Only one published report showed no improvement over Lamaze technique from the addition of hypnosis, though both LaMaze and hypnosis alone lessened pain equally during labor.[16]

Hypnosis has been reported helpful in the conversion of the breech presentation to vertex[17] and in the treatment of premature labor.[18]

The purpose of this research was to address the question of whether high stress and low social support contributed to birth complications and to determine if hypnosis would protect the high stress-low social support woman from developing birth complications.METHODS

Settings and sources of subjects: The author practiced holistic medicine in San Francisco, California, and, later, Tucson, Arizona. As part of this practice, he provided prenatal hypnosis. Two hundred sixty subjects in the first or second trimester of pregnancy were referred for prenatal hypnosis and included in this study. These patients paid for their visits, or their insurance was billed. Data obtained from the was initially obtained for clinical purposes. Referrals came from family phyicians, obstetricians, naturopathic physicians, and midwives practicing in these areas. Patients seen for their first appointment during the third trimester of pregnancy were not included in this study because the author feared that insufficient time would exist to conduct a thorough evaluation and to provide sufficient treatment to alter birth outcome. (Challenging this belief should be the topic of another study.)

During that same time, the author recruited subjects from these same groups of physicians and midwives for a study of psychosocial factors in the prediction of obstetrical risk. These subjects were told that information was needed from them to study how best to predict risk in childbirth. Subjects were paid for completion of questionnaires and for being interviewed. Informed consent was obtained and the study was approved by the author’s Institutional Review Board. Matched, comparison subjects were obtained from this cohort of subjects, who were not referred for hypnosis. Bias was expected to be against the hypnosis subjects, since 1) they came from the same groups of health care providers, and 2), their providers had not identified them as having special needs which could be addressed by hypnosis. There were approximately 2000 subjects from which to match for the comparison group.

Assessment: A complete medical and psychosocial history was obtained from all subjects, including: (1) Demographic information, (2) Complete family medical history, (3) Ob/gyn health history, (4) Psychosocial history, (5) Past medical history, and (6) Review of current symptoms.

The Holmes-Rahe Life Stress Inventory was administered, along with the Taylor Manifest Anxiety Scale, the Dyadic Adjustment Scale, and the Beck Depression Inventory. The couple was interviewed whenever possible. The woman was assessed for her relationship to her body, awareness of body symptoms and patterns of body tension. The scores on the Taylor Manifest Anxiety Scale were normalized to a 0 to 1 scale, as the scores on the Dyadic Adjustment Scale. That scale was oriented so that higher scores meant greater marital satisfaction. The Holmes-Rahe Life Stress Inventory was assessed over the preceding 3 years.

Couples were interviewed whenever possible and during that interview, information was solicited from which an assessment of the couple's beliefs, experiences, expectations and affective states was made. Assessment was also made of the women's stressors, fears and social support. Interview formats and questions are present as Appendix A.

Matching: Subjects in the comparison group were matched with subjects in the hypnosis group so that their values lay within the same intervals defined below:
a) Age: 15-19, 20-24, 25-29, 30-34, 35-39, 40+
b) Socioeconomic status: No insurance, Medicaid, Commercial insurance or HMO, highest level private commercial insurance (ratings of insurance as average or high level was made by the author’s hospital’s billing department independent of this study).
c) Obstetrical risk (defined by the POPRAS system from Harbor General -- UCLA): Low, medium, high.
d) Marital status: Unmarried, married, separated, divorced (at the time of initial interview).
e) Education: Less than 12 years, high school graduate, junior college or college courses, college graduate, graduate courses, graduate degree.
f) Parity: 0, 1, 2, 3, 4+.

Evaluation: Initial interviews aimed to establish close rapport with each subject, so that feelings, fears and complaints could be freely expressed. Interviews usually lasted two hours. Information about the woman's past and current reactions toward herself, her family, partner, work, social, religious and physical experience was elicited. Her knowledge of the physiology of pregnancy and birth, her menstrual experience, family patterns of pregnancy and birth, changes in sexual relationships, attitudes toward body changes, the baby, nursing, and general experiences of pregnancy and birth were assessed.

Note was made of shifts in attitudes and reactions indicated by changes in tempo and intensity of verbalizations, slips of the tongue, innuendo, facial expression, vasomotor activity and tone of voice. Physiological monitoring was included when possible and changes in blood pressure, heart rate, skin conductance, skin temperature and muscle tension were noted when associated with specific subject matter.

The interest or capacity of each woman for participation varied. Some had but little experience thinking about themselves or that which had happened to them and expressed themselves poorly. Some subjects who verbalized poorly gave crucial, pertinent material once encouraged to talk about themselves. Others were defensive and produced scanty material.

These interviews represented different experiences to different patients. To most, they gave a much needed feeling of being an individual in whom others were interested. To a few, the interviews were simply an opportunity to be a part of a study, and to a couple of women, the interviews provided a serious threat. Most of the patients, however, soon came to regard the interview as a helpful experience--an opportunity to talk about anxieties and problems.

Observations of the prenatal care provider were elicited by telephone interview or a data form sent in the mail. Obstetric data and all physical examination findings during the course of pregnancy and childbirth were abstracted from prenatal care records, requested after delivery (the woman signed a records release form during the initial interview). Every effort was made to learn as much as possible about the patients in terms of their psychological functioning, cultural background and life experiences.

Interview records were examined in accordance with Glaser’s method of grounded theory.[19] In this method, qualitative data is examined with an eye toward data reduction. All possible categories which make sense clinically and theoretically are applied to the data. Categories are tabulated and reviewed. Categories are collapsed and combined when possible and logical to obtain a limited and manageable number of variables. A continued coding, sorting, and evaluating process eventually results in a data reduction scheme which makes sense and represents what is available in the data.

For example, the statement, "I am afraid of pain in childbirth", was coded as a fear response. Initially it was called “personal fear of birth, then fear of birth, and finally, fear, as categories were combined. By taking the verbal statements, reviewing any descriptions of associated affective expression, a statement could be made about the intensity of the fear. Statements made were rated on a +3 to -3 scale. "I am afraid of pain in childbirth" became a 'Fear' statement, with a numeral rating assigned to represent its intensity. Appendix B lists the final coding format that developed through the grounded theory process.

The final seven categories to arise from the coding process included:
(1) Fear,
(2) Anxiety-stress,
(3) Maternal self-identity
(4) Beliefs,
(5) Psychosocial support from the partner,
(6) Psychosocial support from the mother's mother,
(7) Psychosocial support from friends.

A team of three clinicians assigned responses to the appropriate category and rated the response for intensity . The frequency of occurrence of a specific response and the magnitude or intensity of the responses were sufficient for clinicians to grade responses from -3 to +3 according to the strength of the statement. Comparative adverbs of 'very', 'mildly', etc., were included as indicators of the magnitude of the psychological state. The verbal responses of the women were differentially weighted in the specific content categories in proportion to the assumed intensity represented by statements made and interviewer notes. Values were assigned to all the verbal responses made. One type of direct verbal report of the subjective affective experience, such as, "I am anxious", would be classified in the 'anxiety-stress' category, and have a weighted value of a -2, while the same statement with a greater intensity, " I am very anxious", could be weighted -3. Each of the women's responses were assessed with the value weighted on each variable to develop a profile of her psychological attitude during pregnancy. The sign of the rating (+ or -) was in accordance with the hypothesized relationships of how this factor would affect the birthing process. The descriptors provided were those which worked for the raters to achieve over 85% agreement. They were developed through rating patients together prior to beginning the study. If the raters could not agree through consensus, the average of their ratings was taken and rounded. The inter-rater reliability was checked on every fifth patient and remained above 0.85.

Treatment: If hypnosis were successful it would be expected to prevent patients with many adverse factors from having abnormal birth complications. If hypnosis was not successful it would be expected to have no impact on outcome.

The general approach used for prenatal hypnosis was oriented toward problem-solving and was perceived as brief, not as insight-oriented nor psychoanalytically-based psychotherapy. Goals included increased relaxation, decreased anxiety, increased sense of trust of social support, realistic fear and a feeling of confidence that the woman could cope adequately with the pain of labor. Visualization was used to guide the woman through an imaginary experience of giving birth, thereby decreasing fear and anxiety. Careful notes were made of the interviews. Audio and videotapes of representative hypnosis sessions are available upon request.

The mean number of prenatal interviews was 5. The mode for number of psychosocial sessions was three. The minimum number was one and the maximum, 60. All hypnosis was provided by the author. Subjects in the comparison group were seen for two-three hours total, usually twice.

Outcome variables: A normal birth was defined as one without obstetrical intervention (no Cesarean, no uterine dysfunction, no fetal distress, no low Apgar scores, no infant resuscitation required, etc). Uterine dysfunction was diagnosed when treated by the doctor or midwife with oxytocin augmentation during labor or with induction. Fetal distress was noted when it was recorded on the labor and delivery record. Apgar scores were recorded on the labor and delivery record. Infant resuscitation efforts were described on the labor and delivery record. All of these were obtained from the hospital records, or, for home birth, from the midwife’s birth records.

An abnormal birth, therefore, required the use of obstetrical technology, including Cesareans, induction and augmentation of labor with oxytocin, fetal distress resulting in intervention or fetal scalp sampling, low Apgar scores, and postpartum hemorrhage. An obstetrician and two certified nurse-midwives reviewed each case to assess normal versus abnormal. They were blind to the existence of this study. They agreed on 95% of cases. For the remaining cases, their consensus was accepted. These were borderline cases in which, for example, blood loss was on the borderline of excessive or fetal distress was on the borderline of being excessive.

Data analysis: The T-test procedure and the discriminant analysis procedures from the Systat statistical package for the MacIntosh computer was used. Statistics provided are already corrected using the Bonferoni method for the number of comparisons made. Chi-square tests were used to test statistical signficance of differences between groups. Variables were compared within the total sample of 520 women by actual outcome group. Then comparisons were reconsidered with subjects grouped by the use of hypnosis or not.

RESULTS

Table 1 compares demographics between women having normal births and abnormal births in this sample. No significant differences were expected between women in the hypnosis and the comparison group, since matching procedures were used. Table 1 shows no signficant differences, either, in demographic variables, when women were compared between for actual outcomes. Age of the total sample of patients varied from 18 years to 39 years with an average of 27 years. Years of education ranged from 9 to 19, with an average of 13 years. Fifty-two percent of the women were primigravidous, 24% were secundigravidous, 11% were having their third child, and 13% were pregnant with their fourth or greater child. No significant differences in level of medical risk were found between subjects who had abnormal outcomes versus normal outcomes. No differences were found in the range of distance from place of birth for women in normal and abnormal outcomes.

Contribution of Medical and demographic variables to risk: Table 2 shows no differences in the two groups for members having previous live births, previous abortions and previous miscarriages. Women in the abnormal birth group showed significantly more previous (to the pregnancy) infections, injuries and hospitalizations. These events were not obstetrical or gynecological and did not increase their risk on the Popras Obstetrical Risk Screening Criteria. There were no differences in number of prior surgeries or diagnosed illnesses. Women in the abnormal birth group showed more frequent past drug use. Neither group was using drugs during the pregnancy. Women in the normal birth group were more physically active.

Emotional state variables. Table 3 shows the differences in the emotional state variables. All four variables were significantly different between groups. Women in the abnormal birth group showed more anxiety-stress and fear. Their beliefs were more negative toward birth. They showed less maternal identity.

Table 4 compares the emotional state variables between the normal and abnormal birth outcome groups, grouped for the use or non-use of hypnosis. The comparison group who did not receive hypnotherapy showed significant differences between anxiety and stress when normal and abnormal birth outcome groups were compared. These differences disappeared when comparisons were made in the presence of hypnosis. The presence of hypnotherapy seemed to inhibit cases of high anxiety-stress who received hypnosis from from having abnormal birth outcomes.

Fear variable. The control group who did not receive hypnotherapy showed significant differences between fear when normal and abnormal birth outcome groups were compared. These differences were still present but to a lesser degree when comparisons were made in the presence of hypnosis. The presence of hypnotherapy appeared to prevent women with high fear who received hypnosis from from having abnormal birth outcomes, but not to the same extent as for anxiety-stress. A significant difference was still present between women having abnormal births and women having normal births, both of whom received hypnotherapy.

Maternal self-identity variable. The control group who did not receive hypnotherapy showed significant differences between maternal identity when normal and abnormal birth outcome groups were compared. These differences disappeared when comparisons were made in the presence of hypnosis. The presence of hypnotherapy seemed to inhibit cases of low maternal identity who received hypnosis from from having abnormal birth outcomes.

Belief variable. The control group who did not receive hypnotherapy showed that negative beliefs about birth were significantly associated with abnormal birth outcome. These differences disappeared when comparisons were made in the presence of hypnosis. The presence of hypnotherapy seemed to inhibit cases of women with negative beliefs about birth who received hypnosis from having abnormal birth outcomes.

Depression (BDI). Among the comparison group, increased Beck Depression scores were significantly associated with abnormal outcomes. Within the hypnosis group, this difference was not signficant, indicating that hypnosis protected against the effects of depression on birth outcome. The greater levels of depression in the normals in the hypnosis group further suggests that hypnosis had a protective effect.

Taylor Manifest Anxiety Scale. Among the control group, increased Taylor Manifest Anxiety Scale scores was significantly associated with abnormal outcomes. Within the hypnosis group, this difference was not significant, indicating that hypnosis protected against the effects of manifest anxiety on birth outcome. The greater levels of manifest anxiety in the normals in the hypnosis group further suggests that hypnosis had a protective effect.

Life Stress Inventory. Among the control group, increased Life Stress Inventory scores were significantly associated with abnormal outcomes. Within the hypnosis group, this difference was not signficant, indicating that hypnosis protected against the effects of high levels of life stress on birth outcome. The greater levels of life stress in the normals in the hypnosis group when compared to normals in the non-hypnosis group further suggests that hypnosis had a protective effect.

Social Support Variables. Table 5 shows differences between normal birth outcome women and abnormal birth outcome women on measures of social support. Higher levels of perceived support from the woman's partner (husband, boyfriend, etc.) was signficantly associated with normal birth outcome. Higher levels of perceived support from the woman's own mother was, intriguingly, significantly associated with abnormal birth outcome. Higher levels of support from the woman's friends was statistically significantly associated with normal birth outcome. Higher levels of marital satisfaction as measured by the Dyadic Adjustment Scale was statistically significantly associated with normal birth outcome.

Support from mother's mother. No statistically significant differences or effects were observed.

Support from friends variable. Lower levels of support from friends were associated with abnormal birth in the presence of hypnotherapy than in its absence.

Marital satistaction. For the control group who did not receive hypnotherapy, higher levels of marital satisfaction were associated with normal births, and low levels with abnormal birth. Statistically significantly lower levels of marital satisfaction were still associated with normal birth in the presence of hypnotherapy.

Birth data. In comparing the mean scores between the normal and abnormal birth outcome groups on birth data variables, first stage labor length, Apgar score at 1 minute, and Apgar score at 5 minutes, significant differences were found as would be expected. First stage labor length was shorter, and the Apgar scores at 1 and 5 minutes were better for the normal birth outcome group than for the abnormal birth outcome group (by definition). No significant differences between the mean scores for the normal and abnormal birth outcome groups were found for gestational age, second stage labor length and birthweight, indicating that premature labor did not figure a role in these differences. These results are summarized in Table 6.

Discriminant function analysis was used to correctly classify 91% of the cases correctly into the normal birth outcome group (group N) or the abnormal birth outcome group (group A). Women having normal deliveries were classified correctly with 90.2% accuracy, compared to 92.1% for women having normal births. The canonical correlation was 0.7808 meaning that about eight times out of ten, correct classification occurred. The most significant psychosocial factors were fear and support from the baby's father and drug use. Hypnosis was signficantly associated with normal outcome.

No one particular practice group was significantly associated with abnormal outcomes, suggesting that practitioner practice patterns were sufficiently similar not to contribute to outcome differences. Practitioners who were willing to refer patients for hypnosis or for a study on psychosocial factors affecting risk tended to be more supportive of natural childbirth and had lower intervention rates than their colleagues who would not participate in making such referrals.

DISCUSSION

Examination of the group of women who were evaluated and not offered hypnotherapy revealed that psychosocial variables were related to abnormal birth outcome. Seven major psychosocial variables showed importance to birth problems. These included maternal stress and anxiety, fear, negative beliefs about birth, negative maternal self-identity. Psychosocial support variables of significance included support from the baby's father, support from friends, and marital satisfaction/dissatisfaction as measured with the Dyadic Adjustment Scale. Depression as measured by the Beck Depression Inventory was asociated with abnormal birth as was manifest anxiety (Taylor Manifest Anxiety Scale), and Life Stress over the past three years (Holmes-Rahe Life Stress Inventory).

Providing hypnosis to women at psychosocial risk (as judged by the above criteria) did seem to help them have a normal birth.

Of surprise was the finding that high levels of support from the woman's mother was associated with abnormal birth outcome. This may indicate that the manner in which we rated this variable keyed more into dependency and passivity, or that women need a different kind of support from their mothers than we imagined in conceptualizing our rating system.

This study shows that a psychosocial intervention program can have a positive effect on birth outcome among women who are having full-term labors. Prenatal providers might do well to incorporate a consideration of psychosocial risk factors during prenatal care and to utilize methods such as hypnosis (or others that may prove effective) to help reduce psychosocial risk during routine prenatal care. This can be done cost-effectively, through utilization of a trained mental health professional. This practitioner can interact with nurses and childbirth educators to improve co-ordination of patient care and provide attention to psychosocial risk. Specifically, psychosocial risk reduction involves:

(1) Identification, acceptance and resolution of fears.

(2) Identification of states of high anxiety-tension, with helping the client learn more effective coping styles.

(3) Identification of negative beliefs about birth and parenting, with provisions for reframing and emotional relearning.

(4) Identification of low maternal identity with anticipatory guidance for the mothering role and hypnotherapy to improve self-esteem.

(5) Consideration of strengths and stresses of the woman's support system. Needed interventions included:

(a) Couple's therapy to decrease stress, increase husband's emotional availability, improve lifestyles, etc.

(b) Individual counseling for the husband to address his unique concerns (when indicated).

(c) Network therapy (environmental intervention with the mother's friends (which can be done in childbirth classes),

(d) Therapy with the mother and her mother to facilitate transition and change of that relationship, and/or,

(e) Helping the woman with no psychosocial support to establish needed relationships and resources.

On a broader level, these findings may presage a time when all medicine is practiced more holistically, with mind-body interventions seen as important. When the way medicine is practiced changes to reflect our new understanding of the interactive nature of all aspects of the patient's life on health and disease, we will have come far.

The Pain of Pain

2008-03-16T23:06:00.003-07:00

I was recently reminded of a patient that brings to light the power of the mind in pain perception and control. It also highlights the need for physicians to have more time in appointments to elicit a thorough history and physical. I would venture that we rely on the patient giving forth their history, when in reality, we should be the investigators and follow the channels of questioning like so many tributaries flowing into the sea. Obviously, for confidentiality, the specifics and name of the patient will not be revealed, but there is definitely something to be learned form this courageous woman.

As with so many other days in the pursuit of staying on time, I was failing miserably and was about twenty minutes behind schedule. I received a call from another gynecology group in town that they had a woman referred to them through the emergency room and they did not take her insurance, could I see her, now. There was something about the call that peaked my concern since this had never happened before. They were, and still are, an "all female" group and they were asking me to help this particular patient. There are excellent physicians all around in this office and so I felt they were entrusting the care of this patient to me and I accepted the appointment.

The patient was walked to the back of our office to be weighed, and I could see that she had a terrible rictus on her face that she was in dire pain. Her gait was slow and shuffing like when she moved she was being ripped apart from the inside. There are few times in the office when you think, "this person needs to go the the ER'. Then it hit me, she was just in the ER a few hours ago and they sent her home. Something was not fitting with this puzzle. I called over to the ER and spoke with the physician that had worked with her. She had come in for an excruciating pain in her pelvis that had her doubled over. CT scan and ultrasounds of the pelvis and abdomen had shown no acute or chronic disease. Her labwork was all normal. So, there was no evidence of ovarian cyst, bladder infection, kidney stones, ovarian torsion, colon or rectal problems or anything else for that matter.

After hanging up with the ER physician, I proceeded to the room and when I entered I was greeted by the patient pacing. She tried to smile but was in obvious distress. I asked her what brought her in to the ER earlier tha morning and she told me the story in a nutshell. Basically, for the last two days she had had some pain in the pelvis (pointing to her pubic bone), but that it had reached a point where she was crying and could not function. She needed someone to help her since she felt like something horrible was going on inside of her and she did not know what was happening.

During my exam she had no lower back pain to palpation of her muscles. The pelvic exam had little pain to deep pressure, but I could move her uterus and she would not flinch, yet she could literally not straighten out her legs because of the severity of this mystery pain.

I asked her to get dressed as I stepped out of the room. As I waited I wracked my brain for some sort of differential diagnosis. I mean, here was a woman with a million dollar work-up only three hours ago that proved nothing and by the looks of this patient I was thinking I might have to take her the operating room.

Re-entering the room I sat down facing her. I noticed she was looking at a tapestry I had just purchased that was a beautiful rendition of the seven energy centers or chakras. Basically these are seven energy centers in Yogi traditions. These seven centers can also be thought of as seven different consciousness centers and they each have different correlation to the body and mind.

The second chakra (svadisthana) is the area of the sacrum or the pelvis in both men and women. This is the energetic center of personal power, creativity and sexuality; physcial survival, issues of control, and one on one realtionships. I looked at the tapestry and then back at the patient. It was then that I had the feeling that I should ask her a question around the second chakra. Obviously a question like, "So tell me about your second chakra" would not be appropriate, so I fashioned something else. I looked at her and asked, "In the past few weeks have you had any issues with intimate realtionships or trust?" There was a silence, and then a flood of tears and sobbing.

I had pulled the scab off of a wound that was recently reinjured. In the past week, the patient had been told by her husband, that he was having an affair. This is obviously catastrophic for anyone, but she had a second issue. As she was dealing with the emotional rollercoaster of infidelity, she had a memory come back that had been filed away. She remembered and now recently relived, that when she was seventeen, she was raped. During the rape the man involved tried to kill her by drowning her, but he stopped short of her death. When she told me all of his I was dumbstruck and sat there for a few moments collecting my own thoughts.

"If someone goes through a stressful period in their lives, it is not unusual for them to get a headache or migraine correct?' I asked her and she agreed.

"So with all of this coming up two days ago, is it not possible that you could be having a migraine in your pelvis?" She stopped and looked at the wall again and said that she felt this could be possible as well. After a few more moments, I proposed that she see a psychiatrist and allow herself to go through this now that it had been unearthed. I did not want her to suppress this memory again. the patient agreed to the therapy and was scheduled to return to see me in one week.

When she returned she was walking and comfortable. She said that she had seen the therapist three times last week, and while she was still having pain, it was mild at best. She was continuing to with her therapy and was no longer taking any pain medication. Now I understand that this could have been mere coincidence that she improved, but I would like to think that she was now dealing with it rather than medicating it. The conundrum for the allopathic physician is that we have to practice defensive medicine and spend a million dollars for fear of missing something. We must spend less time with patients and order more tests, not because we want to, but because we have lost our connection to spirit. It is this energetic connection that gives us life and it is this energy that might cause pain if unbalanced. It would be my wish that we could all understand ourselves better by understanding other types of medical practice. Simply sticking with the Western medical model with this patient would not have been helpful and may have wound up in a an unnecessary surgery.

It is our duty as physciains to know and care. It is the job of the patient to care to know.

The Yoga of Menopause

2008-02-24T19:47:00.002-07:00

When most people hear the word yoga, they think of postures (asanas) and saying the mantra "om". In reality, similar to Buddhism, yoga has an eightfold path with characterisitics that apply to most situations. I have been treating women with menopause for close to 14 years and there is no good answer. I have come to discover, that like yoga, maybe menopause care alos has an eightfold path. In this post I wanted to open a discussion as to the yoga of menopause, and I would like to hear from readers, their experience with any of the eight characterisitics.

YAMA (How you treat others in the world around you).

The yama of menopause would also potentially include, how you treat yourself. Be easy on yourslef and do not treat yourself as though you are a broken machine. Menopause is natural. Do not cheat on giving youself time for healing. Many women with menopause are also having issues with libido. The practice of yama would give you the ability to look at your situation as a couple and not just the individual. Most women with libido issues feel this problem is simply theirs, when in reality, there is a strained relationship.

NIYAMA (Inner discipline and responsibility).

Basically, treat your body like a temple. Eat many multicolored frutis and vegetables and exercise your body regularly. Try to be aware of something Divine other than yourself, or something that is in control outside of your body. Surrender is the most difficult and yet, the most productive spiritual course any of us can follow. Educate yourself on the menopausal change from hormones, herbal preparations, and body therapies to meditation and other movement practices.

ASANA (Yoga)

This is the yoga practice that we Westerners see in strip malls. Yoga asanas are less for staying fit and more for preparing the body for meditation. If you can control your body then would you not be able to control your menopausal symtpoms. Personally, I am a fan of Bikram Yoga, or hot yoga. Rather than fearing the heat and the hot flash, attack it and make it part of your life. Practicing Bikram or hot yoga would give you the ability to embrace the heat and make it your own.

PRANAYAMA (Control of the breath)

Focus on your breath. Notice that you breath. Focusing on your breath removes external distraction. Are you constantly distracted by your medical condition. I would challenge you to focus on your breath the next time a hot flash ensues. Try not to think about anything but your breath. Cleanse yourself with claen refreshing air and nothing else.

PRATYAHARA (Withdrawl of the senses)

Are you easily bothered by an itch on your nose, or can you smell popcorn at the office from yesterday. Are you constantly focusing your senses outward into the world around you. The practice of pratyahara occurs when one is meditating. The next time you have that mood swing or hot flash and can sit and focus on your breath try to withdraw the sense of heat from your body. Try to detach from it. The symtpom of menopause is temporary and simply a dream from which you can awaken.

DHARANA (Concentration)

The goal is to still the mind — gently pushing away superfluous thoughts — by fixing your mind on some object such as a candle flame, a flower, or a mantra. In dharana, concentration is effortless. You know the mind is concentrating when there is no sense of time passing. I realize that this is extremely difficult to do when something is annoying you, but, with time this is no longer something you have to practice, it becomes your medication. Instead of focusing on the events that are causing you discomfort, shift you focus towards something like snow or a point on your face.

DHYANA (Uninterrupted concentration)

Uninterrupted meditation without an object is called dhyana. Concentration (dharana) leads to the state of meditation. The goal of meditation is not unconsciousness or nothingness. It is heightened awareness and oneness with the universe. How do you tell the difference between concentration and meditation? If there is awareness of distraction, you are only concentrating and not meditating. The calm achieved in meditation spills over into all aspects of your life — during a hectic day at work, shopping for groceries, or focusing on the distractions of menopause.

SAMADHI (Bliss)

Can a woman suffering menopause have samadhi? Well of course she can. Much of the problem in this Western culture is the fact that we try to achieve samadhi with with medication or hormone replacement. There is nothing wrong with hormone replacement therapy, but it is a fals god. To achieve samadhi is to conquer menopause's control over you and to become one with the universe. Obviously, this is goal and the most difficult portion to achieve.

The eight limbs work together: The first five steps — yama, niyama asana, pranayama, and pratyahara — are the preliminaries of yoga and build the foundation for spiritual life. They are concerned with the body and the brain. The last three, which would not be possible without the previous steps, are concerned with reconditioning the mind. They will help you attain enlightenment (symptom relief) or the full realization of oneness with Spirit. Enlightenment lasts forever, while relief from taking a pill can disappear by letting your prescription expire.

A Rant - Tale of the Tape

2008-02-07T16:29:00.002-07:00

It is truly sad that allopathic medicine is so judgmental that there is really no room for other types of medical care. The allopathic medical model is relatively young when compared with methods like Ayurveda or Chinese Medicine that have been around for millenia. The true controversy is submerged in evidence based medicine. If it doesn't have a study behind it, well then, it just isn't good medicine. even good studies have flaws or the researchers skew the data to reflect their personal bias. Part of the problem comes from the fact that the ultimate scientific premise is that of the hypothesis. if you have a hypothesis can you truly be unbiased in either direction? it would be my challenge that if you are asking the question you probably already have an answer in your head and you hope the research will flesh it out.

Part of the pomp of allopathic medicine is that it prides itself as being the only arm of medicine that is evidence based. It feels as if it is the only form of medical care that is steeped in scientific method and uses deduction to determine the diagnosis. Physicians that feel that science is God are truly falling prey to the Pre-Trans Fallacy of Ken Wilber. By supposing that Science is God and everything can be deduced by science basically eliminates the transpersonal experience. The other end of the spectrum is the religious zealots that feel everything is based on religion. These individuals exclude the fact that there are truly wonderful scientific experiences.

Medicine is not politics (or is it). There is separation of church and state, but does there have to be a separation of religion and medicine. Unfortunately, many physicians are soulless. I do not mean this in the sense of religion or atheism. They simply have lost their spirit to the practice of medicine and science and they feel that spirituality has no role in healthcare. These are not truly healers, these are medical robots.

Why is it that physicians that pride themselves on scientific have such a hard time accepting the trend of Integrative Practice. Why? Again, they have no spirit. Is it so horrible to use your allopathic acumen to diagnose a native american patient with diabetes and at the same time udnerstand their culture and spirutality. Is it so horrible that the patient may then go home and participate in a sweatlodge with their entire family at their sides. Maybe it is the life of the allopathetic physicianworking horrendous hours and strapped to a lifestyle ever slipping away that is blurring the lines of reality and myth.

Archetypally the physician at large has become the wounded-healer, and many more have become the harsh judge. They not only judge their colleagues they judge their patients. The main reason for lawsuits agaisnt physicians is not becuase of a lack or science, but because that physician lacked the ability to talk with the patient and develop a relationship.

Should the physician separate their religion and personal beliefs from their practice of medicine? I am certain that the patients do not do so. I would think that a physician would have a difficult time dissociating himself/herself from their beliefs (is not this dissociation the crux of the problem in the first place). I think that doctors should be true to themselves. If they are against the morning after pill then don't prescribe it, but you should have a list of places where the patient can obtain the medication. They should not issue a judgement or preach to the patient, just as other physicians should not preach to other health care providers.

Should physicians stay true to their allopathic training? The training that pounded them into automatons and made them angry that medicine is falling apart right before their eyes because of the lawyers and insurance companies. The surgeons judge the internists and vice versa, and this has nothing to do with lawyers or insurance companies; this has to do with the legacy of the venerable physicians before us. They have created this debacle and now they sit back from their ivory towers and mock journals and judge us for living through their mistakes.

As medicine continues to evolve we should learn to become more accepting of other practices and educate them on why we believe the things that we do. If the other practices such as pharmacy and chiropractic, acupuncture, and homeopathy were free to feel that they could talk with us then maybe we could educate eachother for the benefit of the patient. Instead we are ready to institute "Marshall" law and burn them at the stake, and we wonder why they will not come to us for help. I am confinent in my allopathic training and I do not feel threatened by the naturopath. I am an M.D. not an N.M.D. I would imagine that this can be confusing for the patient, but I have training and I bring this to my office, not a disgust for someone with other labels after their names. As long as other complimentary providers are practicing within their scope, are not harming the general public, and are providing a service deemed legitimate, but the state boards of medicine, then so be it.

The ego is a dangerous thing if left unregulated and this is the basis of many spritual pracitices. Maybe those providers that have such fear of being rolled into a consortium and hold on to conspiracy theories should come out the corners themselves and particpate in the debate instead of shooting arrows. Collateral damage can destroy bridges.

Allopathic or Allopathetic medicine? I'll leave you to decide.

Hillary Care or Who Cares

2008-01-31T16:37:00.000-07:00

Hillary Clinton, during the Clinton administration, was appointed to a special commission to help save the medical system. At the time, she was destroyed by the special lobbyists from the American Medical Association and big pharmacy and insurance. She has since learned her lesson. What was the lesson? Well, you don't want to buck the system or you get smashed in the mouth. It was a highly unfortunate turn of events, because she has now become a candidate with a large bankroll from insurance and pharmaceutical. All of the money aside, let's look at some of her more prominent statements on the healthcare reform issue.

The American Health Choices Plan gives Americans the choice to preserve their existing coverage, while offering new choices to those with insurance, to the 47 million people in the United States without insurance, and the tens of millions more at risk of losing coverage.

The Same Choice of Health Plan Options that Members of Congress Receive:Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.
A Guarantee of Quality Coverage: The new array of choices offered in the Menu will provide benefits at least as good as the typical plan offered to Members of Congress, which includes mental health parity and usually dental coverage.

Overall, this is a wonderful statement, but what is the part that says "at least as good" and what exactly does that mean. This all sounds too difficult. Why not just give everyone the same plan and do away with the other options.......the answer.....big insurance doesn't want this.

Americans who are satisfied with the coverage they have today can keep it, while benefiting from lower premiums and higher quality.

Reducing Costs: By removing hidden taxes, stressing prevention and a focus on efficiency and modernization, the plan will improve quality and lower costs.
Strengthening Security: The plan ensures that job loss or family illnesses will never lead to a loss of coverage or exorbitant costs.
End to Unfair Health Insurance Discrimination: By creating a level-playing field of insurance rules across states and markets, the plan ensures that no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums.

Who is happy with their current insurance plan? Ahhhh, noone. How are you going to eliminate insurance discrimination; that sounds like chin-music to me.

Relying on consumers or the government alone to fix the system has unintended consequences, like scaled-back coverage or limited choices. This plan ensures that all who benefit from the system share in the responsibility to fix its shortcomings.

Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information.
Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.
Providers: will work collaboratively with patients and businesses to deliver high-quality, affordable care.
Employers: will help financing the system; large employers will be expected to provide health insurance or contribute to the cost of coverage: small businesses will receive a tax credit to continue or begin to offer coverage.
Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.

Sounds like they are going to make everyone do something. You must play nice, you must take care of yourself. McDonalds, you must serve healthy foods. Doritos, you will not make those delicious chips, or at least refrain from marketing them to the obese. You simply cannot tell people what to do and then leave them to their devices. I mean, just say it, I want to provide Universal Coverage. She wasn't afraid to say this ten years ago. Oh yeah, that was before she was punched in the mouth. Before they made fun of her cankles.

Senator Clinton’s plan will:

Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.
Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.
Create a New Small Business Tax Credit: To make it easier-not harder-for small businesses to create new jobs with health coverage, a new health care tax credit for small businesses will provide an incentive for job-based coverage.
Strengthen Medicaid and CHIP: The Plan will fix the holes in the safety net to ensure that the most vulnerable populations receive affordable, quality care.
Launch a Retiree Health Legacy Initiative: A new tax credit for qualifying private and public retiree health plans will offset a significant portion of catastrophic expenditures, so long as savings are dedicated to workers and competitiveness.

All of this sounds good. I especially like the small business tax credit. Fixing the holes in Medicaid? More like fixing a black hole. Medicaid is a disaster. Taxpayers pay for the uninsured to have babys while they just continue to have babys becuase Medicaid keeps them dependant on the system. This is not a safety net, it is a hair net, and you know how well those work.

Most Savings Come Through Lowering Spending Due to Quality and Modernization: Over half the savings come from the public savings generated from Senator Clinton’s broader agenda to modernize the heath systems and reduce wasteful health spending.
A Net Tax Cut for American Taxpayers: The plan offers tens of millions of Americans a new tax credit to make premiums affordable-which more than offsets the increased revenues from the Plan’s provisions to limit the employer tax exclusion for health care and discontinue portions of the Bush tax cuts for those making over $250,000. Thus, the plan provides a net tax cut for American taxpayers.
Making the Employer Tax Exclusion for Health Care Fairer: The plan protects the current exclusion from taxes of employer-provided health premiums, but limits the exclusion for the high-end portion of very generous plans for those making over $250,000.

So, another plan that is hopelessly lost, but making good time. The candidates are too worried about their war chests to really get on with the issues. In America, you buy your way into the White House. Patients sit it ER's for eight hours. It costs thousands of dollars to the tax payers to fund their own personal medical plans and then when they need them.....they get denied. Has anyone seen the movie SiCKO? I am not a big fan of the director, but he exposed the system. It makes you SiCKO to watch the documentary, and it does so, because it's true and we all know. They know it, you know it, and the insurance companies know it.

Obama Health Care - The Good, The Bad, and The Ugly

2008-01-22T23:36:00.000-07:00

Senator Barak Obama is definitely a likable fellow. He is very well spoken, seems genuine, and has a fire that resonates with many. The true question hanging over Senator Obama's head is, "What experience does he have?". I understand that he has spent some time in the Senate and that he has a background as a lawyer (what politician doesn't). It was reported in the New York Times on October 28,2007 that Senator Obama has received $2.2 million in donations from the health care industry. This does not sound good for someone promoting change. I thought I would look at Senator Obama's health care policy in three sections; the good, the bad , and the ugly.

THE GOOD

Mandatory Coverage of Children: Obama will require that all children have health care coverage. Obama will expand the number of options for young adults to get coverage, including allowing young people up to age 25 to continue coverage through their parents' plans.

Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.

Portability and choice. Participants in the new public plan and the National Health Insurance Exchange will be able to move from job to job without changing or jeopardizing their health care coverage

Require full transparency about quality and costs. Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs

Reform medical malpractice. Obama will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctor-patient relationship and reduce the need for malpractice suits.

Improve Mental Health Care. Mental illness affects approximately one in five American families. The National Alliance on Mental Illness estimates that untreated mental illnesses cost the U.S. more than $100 billion per year. As president, Obama will support mental health parity so that coverage for serious mental illnesses are provided on the same terms and conditions as other illnesses and diseases.

THE BAD

Align incentives for excellence. Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded for achieving performance thresholds on outcome measures.

Obama will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function.

National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

THE UGLY

Employer Contribution: Employers that do not offer or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small employers that meet certain revenue thresholds will be exempt.

Flexibility for State Plans: Due to federal inaction, some states have taken the lead in health care reform. The Obama plan builds on these efforts and does not replace what states are doing. States can continue to experiment, provided they meet the minimum standards of the national plan

Overall, Senator Obama seems to have more positives than negatives. I do not agree with making small business owners bear the brunt of the employee health care coverage since this would put undo burden on the employer. If government were to give tax cuts to the small businesses or let them join together in order to get better rates then this may be achievable. He comes close to declaring a Universal Health Care system, but his fear of upsetting the Pharma and Insurance lobby is showing. His plan, simply will not work, for one good reason. Medicine can no longer continue to fiunction in a "for profit" model. He has many good ideas and is much more descriptive than McCain, but I fear he is trying to please too many "lobbies" and is not going far enough to protect the patients.

John McCain - "Straight Talk" on Healthcare

2008-01-17T22:00:00.000-07:00

I am going to dissect the candidates and their main points on the health care issue as dictated on their websites. I have chosen to start with John McCain, because I like him. I may have issues with him on health care, but I think that he truly believes in what he is saying and he is not being influenced by lobbyists (well, at least minimally).

1). John McCain believes the fundamental problem with health care are the risings costs.

Hard to disagree, but my question is why are the costs so high......let's see.

2).Families should be in charge of their health care dollars and have more control over their care. We can improve health and spend less, while promoting competition on the cost and quality of care, taking better care of our citizens with chronic illness, and promoting prevention that will keep millions of others from ever developing deadly and debilitating disease.

This is a nice idea, but how should families be in charge of these health care dollars, and aren't we already in charge of our health care dollars? Competition in medicine is a horrible idea. I do not like the drug companies, hospitals, and practitioners having to advertise to make themselves look good. Competition breeds negativity; I believe that we should strive for a system that is based on sharing of information and freedom of that information.

3).Promote competition throughout the health care system - between providers and among alternative treatments.

Again, I think this is a recipe for disaster. This will not drive down costs, this will close hospitals and physician offices. Just because a hospital or physician office is competitive and well marketed does not mean it is giving better care.

4). Make patients the center of care and give them a larger role in both prevention and care, putting more decisions and responsibility in their hands

I truly believe that prevention is the key. Physicians must be compensated for keeping their patients healthy, and not for treating disease. I mean, physicians should be compensated more if they keep their patients healthy.

5).Pass tort reform to eliminate frivolous lawsuits and excessive damage awards. Provide a safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols.

The hidden message here is that the doctors will be protected if they conform to mandated forms of treatment. This would be great if the protocols and guidelines come from the medical community and not bureaucracy.

6).Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification.

I am a patient, employee, and employer........I like this notion.

7).Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise - vital life information.

Let's not focus on just the children; the parents are obese too many times. Maybe Senator McCain could have Richard Simmons as his vice president.

8).Protect the health care consumer through vigorous enforcement of federal protections against collusion, unfair business actions, and deceptive consumer practices

I am not sure who this is aimed against and I am not sure that it would really protect the consumer. United Health Care recently purchased Pacificare. Two major health care giants merged and you barely saw it on the news. As a physician they are two of the most difficult insurance companies to work with (they don't like to pay). I have Pacificare as my personal PPO and they have denied more than half of the visits were I have gone to the doctor for my own health care. Keep them from colluding, sure; we might want to keep them from merging as well.

9).Controlling health care costs will take fundamental change - nothing short of a complete reform of the culture of our health system and the way we pay for it will suffice. Reforms to federal policy and programs should focus on enhancing quality while controlling costs.

Complete reform will not come from a President, Senate, or Congress. Something of that magnitude will have to come from a grassroots revolt from the people. Only when we all stand up and demand a change in this system, will it actually change. There are too many monopolies and powers in place for someone to change it from within the system. This change will have to come from outside......from us.

Overall, I am somewhat disappointed with John McCain's Health care platform. It is very vague, at best, and it looks as if it were written by a junior staff member that has no concept of the health care system. His plan has no mention of how he plans to do any of his suggestions. I don't know, but it looks like health care is not at the top of John McCain's issues. Maybe he is too concerned with border issues here in Arizona, or maybe he has not seen the fact that in Arizona we have six state medicaid plans (the most in the nation I believe). We are not a wealthy state and have a poor teen pregnancy rate. Like I said, I like John McCain as a human being, but on the issues of health care, I still don't know where he stands.

Mantras - Finding Your Voice

2008-01-08T20:48:00.001-07:00

I am sitting in the kitchen tonight watching the Hew Hampshire Primaries (wondering how we can pontificate a candidate from only two states voices) and listening to the press liberate Hillary Clinton. A week ago she was too tough; yesterday she was too soft. I would imagine, that somewhere in between she was simply being human. I cannot say that I am Clinton supporter since I am not certain where the candidates stand on the issues. I would like to devote another post to each of the top candidates positions on health care, and my take on the issues (from both sides of the stethoscope).

What struck me about tonight's results with McCain winning the Republican side, and currently, Obama and Clinton deadlocked, is that we must listen to what resonates within us. Every candidate is a vibration that will resonate with each and every one of us. I believe that if you not only listen to the words, but feel the mantra within the voice you will feel the candidate on a different level.

In 2000, I remember, being glued to the television hoping that John McCain would win the Republican nomination. It was more than his message, there was something about the person that made me feel proud of being American. Over the last eight years, I have become apathetic about politics, but recently, I began reading a book called Healing Mantras by Thomas Ashley-Farrand and it became apparent to me that our election process is about empowering ourselves. What other item do we possess that is better suited for empowerment than our voices.

Whether it be for abundance, health, or change in the world, mantras are a way for each of us to speak to our gods. The word Mantra is Sanskrit and can have many meanings, "divine speech" being one. Most if not all worldly religions have mantras from the simple recitation of "Om" to the "Hail Mary" in Roman Catholic prayer.

What I would like for all of us to do in this new year is to find our personal Mantras. Start with those mantras that have been handed down from thousands of years gone. There are many, and in the book listed above, they have different powers and meanings. It has been recommended that these Mantras be repeated daily for at least 40 days (a magical number in most religions). Whether the Mantras themselves are the means for the magic or the repetition aids the individual by the power of positive thought, there can be positive changes.

Whoever wins the primaries and eventually the presidential elections deserves our reverence as the leader of this wonderful country. We, however, have the ability to change our personal lives and thus the lives of family members and communities by increasing the vibration of our own energy. Singing or articulating a Mantra and speaking with the divine is one way that we can positively affect our health and outlook on life. It all starts with you.

What do you say?

Premenstrual Syndrome - The Storm Before the Storm

2007-12-13T14:52:00.000-07:00

What does a man know about PMS? Let me tell you, being surrounded by women in my office, all day long, I have learned to become the expert spectator; this is by far the best position for a man.

All joking aside, Premenstrual Syndrome (PMS) or the more politically correct Premenstrual Dysphoric Disorder (PMDD), can interfere with many social, family, and work activities.

In looking at the disorder from a physiologic perspective, many women have been found to have high levels of estrogen with low levels of progesterone (Dhar et al. 1991). Other causes or factors associated with PMDD are obesity, diet and nutrition, and lifestyle issues

CLASSIFICATION AND DIAGNOSIS

PMS-A - Anxiety
PMS-H - Hyperhydration
PMS-C - Cravings
PMS-D - Depression

Obviously, most women will have a combination of these four classifications. As many women are also aware, many of the symptoms in PMS are related to changes in their hormonal levels; specifically the estrogen to progesterone ratio. A physiologically normal woman will have a Progesterone to Estrogen ration of 120:1. In PMS-A it has been shown to be 48:1 and in PMS-D it elevates to 274:1. It should also be noted that diet plays an essential role and the specific type of fat consumptions is important. Women consuming a majority of Omega-6 fatty acids (American Diets) tend to have more issues with PMS than those women with diets higher in Omega-3 fatty acids (Mediterranean diets).

Treatments:

PMS-A (Anxiety) can be treated with diet, mineral supplementation, and a more natural addition of progesterone. With all PMS, I would highly recommend meditation and some other form of Mind-Body techniques that can provide control and regulation

PMS-D (Depression) there tends to be higher than normal levels of progesterone. Progesterone has a calming effect on the neurological system and it can be helpful in insomnia. Obviously, there can be many issues surrounding depression and women with this type of PMS should seek the help of a health professional

PMS-C (Cravings) or issues with glucose intolerance. Even though these women tend to have cravings surrounding sugars due to volatile sugar levels in their bloodstreams, they should strive to eliminate simple sugars from their diets. Diets rich in unsaturated fats such as the Anti-Inflammatory or Mediterranean Diets should be considered.

NUTRITION AND SUPPLEMENTATION:

The following supplements may be helpful in reducing the symptoms of PMS.

Calcium and Vitamin D (PMS and Calcium)
Magnesium (Quaranta, S. 2007)
Zinc ( Postgrad Med. 1985 May 15;77(7):32-7)
Vitamin B6 (J Womens Health Gend Based Med. 2000 Mar;9(2):131-9)
Vitamin E (J Reprod Med. 1987 Jun;32(6):400-4.)
GLA (Am J Obstet Gynecol. 1984 Oct 15;150(4):363-6)
Chasteberry (Vitex) (J Pharm Pharmacol. 2007 Sep;59(9):1307-12)

MIND-BODY MEDICINE AND PRACTICES

Personally, I prefer to combine and therapies with a mind-body connection. PMS and many female disorders have such a strong, and unfortunately, negative psychiatric component. In many cases, this disorder, listed in the psychiatric diagnosis bible DSM-IV and there are physicians that do not feel PMDD is even a legitimate disease process. (See article)

Donna Eden in her book, Energy Medicine,makes a reference to PMS as a gift. “PMS drops you deep into your own being, and your own truth explodes forth. Whatever you have been successful at burying or denying to yourself bursts forth at this time of the month. It is a truth serum from which you cannot escape, and if you carve out space for it, PMS makes you wiser” (Eden, 1998).

I have come up with a simple ceremony geared towards reclaiming your control and to help in establishing ritual. I find it fascinating in our society that we are very ritualistic when it comes to ingesting medications and when we undertake surgical procedures, but we have eliminated daily ritual in our lives. Let us look at a simple ritual for PMDD or PMS that could possibly help a woman regain superiority over her second chakra.

Find a sacred space. That place where you feel the most comfortable and where you will uninterrupted.
Set the stage by filling the room with the scent of bergamot or neroli; fennel, rose, geranium, or citrus fruits will work as well. If you do not have incense or oils you can try filling the bathtub will bath salts.
On the floor of your sacred space, create a sacred geometric shape such as a circle or triangle; whatever appeals to you at the time. It is also important that you create this circle or shape with whatever is pulling you. If you are outside and wish to surround yourself with river rock or are inside and have potpourri it only matters that you create a space for"you".
Before stepping into your space, set an intention. It may be something simple like "Give me the freedom to control my fears and anxieties". With the intention, breath deeply and step into the circle.
Sit or lie down in your space, comfortably, but not so that you will fall asleep. Sleep can be a wonderful part of your ceremony, but save that for after the ritual.
Meditate on your intention. Meditate on the word control and only the word control. Feel the colors of control and the smells of control. Open the top of your head (figuratively) to the archetype of the Benevolent Queen. Allow the healing powers of other women to enter your spirit. Claim it as your own. I would recommend this type of contemplative meditation for 15 minutes to start; increase your time as you desire.
When you have truly brought the word control to the point where you feel as though you own it, then bring your focus back to your breathing. Listen to your breath and calm your mind.
Ease yourself out of your meditation and step out of the circle.
Close your ceremony by thanking the sisters that were present with you in your quest and to the power of the moon that influences the cycles of the earth and water.
If your practice becomes more advanced, I have recommended that women try a moonlight stroll in a safe area where they can bathe in the moonlight and focus their meditation while they walk. With every slow step, think the word "control".

In conclusion, there are many different therapies for help with PMDD or PMS. The goal is to try and find the one that is right for you. For many women, they will start with medications like Prozac and other SSRIs. These may be helpful, but so can chamomile tea and and a nice hot bath with bergamot. Be open to the change that is going on in your body and keep a journal to record the journey. Look back at your journal and see if certain practices help more than others. Share the journey, you're not alone.

What is Integrative Medicine

2007-12-05T10:31:00.000-07:00

The conept of Integrative Medicine is to treat the patient as a whole. Thus, Integrative Medicine would be a measure of "Wholistic Medicine". Many of the problems in our current care model is the fact that allopathic physicians are forced to see more patients in the same amount of time; this then has had the effect of shortening patient appointment time. this care model, causes frustration for both the physician and the patients.

The plan with Integrative Medicine is to spend more time with patients. New patient appointments usually last 90 minutes. This gives the provider time to obtain an intense history with the patient including alternative therapies, spirituality, and relationship issues. Within the confines of this visit, the physician will perform an exam and then make recommendations for therapies based on many different modalities. If a woman, for instance, comes into the clinic , with complaints of menopausal symptoms, the physcian may recommend everything from no treatment, to synthetic or bioidentical hormones, to accupuncture, or meditative practices. The patient would receive a gameplan with different recommendations and modalities. The overall goal is to empower the paitent with the choice to try many different paths.

Problems with this model is that insurance companies will no reimburse providers or their patients for face to face contact with the physician. Becuase of this issue many IM providers are fee for service. This does indeed limit those individuals that can pay for this service and excludes a majority of the American population.

The purpose of this blog is to answer IM questions with regards to healthcare. It should be understood that none of the recommendations on this website are to be taken as medical care and we always recommend that you see a physician in your area prior to posting.

Please let us know if you have any questions regarding women's healthcare and IM or alternative medicine questions. We will always try to respond with recent research and studies that are being performed.